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Everything You Need to Know About Crossover Claims in Healthcare4 min read

Crossover Claims
Managing crossover claims appropriately reduces the chances of denials and lead to greater reimbursement rates and prevent medical claims.

Crossover claims are when a patient qualifies for Medicare and Medicaid healthcare insurance programs. In this instance, Medicaid gets billed for any unpaid deductible or coinsurance after Medicare pays a portion of the claim.

Medicaid claims for qualified beneficiaries are electronically and automatically crossed over by a Coordination of Benefits Contractor. An indication on your Medicare remittance will determine whether the claim automatically crossed over to Medicaid. Providers can confirm that their claims are crossing over by examining their Medicare Remittance Remark Code.

Medicare Vs Medicaid

Before we dive into crossover claim processing, we must understand the difference between Medicare and Medicaid programs.

Medicare

Medicare is a government health care program created for 65 years of age or older people. It also covers young adults with impairments and patients who need dialysis or a kidney transplant due to renal failure.

Medicaid

On the other hand, Medicaid is a joint federal-state program that offers coverage to low-income people of all ages. Some individuals may be eligible for both programs due to an overlap in age and other eligibility requirements.

Crossover Claims Processing

The federal centers have established the following guidelines for submitting such claims for Medicare and Medicaid:

  1. For patients who qualify for both programs, you don’t have to submit the claims directly to Medicaid. Medical practitioners must submit all crossover claims to Medicare in order to get compensation.
  2. Following submission, the claim is evaluated by Medicare, which then pays its share of the expense and sends the remaining claim to Medicaid.
  3. The state regulations in the state where you submitted the claims determine the total amount Medicaid will cover. The claim closes after Medicaid reimburses the claim.

Can you submit the claim to Medicaid first?

The claim submitted by the provider will be rejected as a duplicate claim if the crossover claim from Medicare is processed first. If the zero-fill indicator is present on the claim and the provider-submitted claim is processed before the Medicare crossover claim, the provider-submitted claim will be paid.

How to Avoid Crossover Claim Denials?

Your address on file with Medicare and Medicaid may be the reason your Medicaid crossover claims are being denied. These address fields are submitted when Medicare transfers your claim to Medicaid: Addresses for master and pay-to or remittance. You may confirm that both Medicare and Medicaid have the same addresses. Medicaid will deny the claim if the addresses do not match those in its records. The following factors can also lead to denials:

  • Duplicate claims or information-deficient claims
  • Medicare claims that are fully covered and have no extra beneficiary responsibility.
  • Starting and ending dates for claims not covered by Medicaid
  • Health Home

The best solution to avoid claim denials is to handover your crossover claims to full-service medical billing companies. Several medical claims billing services assist in handling crossover claims as well.

Analyzing  Medicare Claim crossover to Medicaid

Remark code MA18 for the 835 transactions or your Medicare remittance will reflect that the claim was an automatic crossover to Medicaid. You won’t send such members a direct bill after the signal appears on their Medicare remittance. The assigned claim number will include the letters “MX” when Medicaid processes a Medicare crossover claim. This is your notification that Medicaid processed your claim as secondary to Medicare.

What are the Advantages of Using a Medical Crossover Insurance Billing Service?

Medical billing companies are adept at filing crossover claims. They are familiar with the procedure, and with them, you can be sure to have the following benefits:

  • Appropriate Medical Codes: The primary cause of claim denials is the inaccurate transfer of specific injuries, therapies, and medical services into general medical codes. Consequently, you should enlist the aid of trained medical coders. The ICD-10 and the most recent medical codes update are well-known among medical claims billing service providers. As a result, they are able to handle the claims using specific codes.
  • Avoid Duplicate Claims: When you submit a medical claim to payers more than once for the same patient’s procedure, therapy, or testing, it is considered duplicate billing. Medical billers make sure that there aren’t any duplicate claims.
  • Meet the deadline for filing: If the claim is filed after the deadline, it doesn’t matter how accurate the data is. It will ultimately end in trash cans. Specific dates must submit Medicaid claims, and your state’s Medicaid program may not honor late claims. Therefore, medical billers file the claims within the allotted period.

We know physicians already have a lot to on their plates. So, let the professionals handle all the crossover claims clutter for you.

Andrew Mark
Andrew Mark
As a healthcare IT expert, I bring extensive experience in revenue cycle management (RCM), medical billing, and coding. I am passionate about simplifying complex healthcare processes and empowering providers with efficient solutions.

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