{"id":12747,"date":"2021-01-18T16:51:05","date_gmt":"2021-01-18T11:21:05","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=12747"},"modified":"2025-04-29T08:01:49","modified_gmt":"2025-04-29T08:01:49","slug":"what-is-the-medicare-crossover-claim","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/","title":{"rendered":"What is the Medicare Crossover Claim?"},"content":{"rendered":"<p style=\"text-align: justify;\">A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and\/or coinsurance. A Coordination of Benefits Contractor (COBC) is used to electronically, automatically cross over claims billed to Medicaid for eligible recipients.<\/p>\n<p style=\"text-align: justify;\">Your Medicare remittance will have an indicator that will show the claim was an automatic cross over to Medicaid. When the indicator appears on the Medicare remittance you will not bill Medicaid for those clients. Providers can check their Medicare Remittance Advice\/ Remittance Remark Code that will verify their claims are crossing over.<\/p>\n<h2 style=\"text-align: left;\">Medicaid Billing for Crossover Claims<\/h2>\n<ul style=\"text-align: justify;\">\n<li>You won\u2019t have to submit claims directly to Medicaid for those Medicaid patients who have both Medicare (Parts A &amp;\/or B) and Medicaid. In most instances, there are no changes to how you bill Medicare however Institutional providers who submit with rate codes are encouraged to include the Medicaid rate code on their claim to Medicare.<\/li>\n<li>The amount paid by Medicaid will be the deductible\/coinsurance or co-pay amounts as indicated on the crossover claim from Medicare.<\/li>\n<li>If a provider bills multiple lines to Medicare and Medicare pays one or more lines but denies the others, the paid line(s) (as long as there are PRs) will be crossed over to Medicaid and the provider must resubmit the crossover payment as an adjustment to Medicaid to add the additional lines. When Medicare claim payment is zero, that claim will still be crossed over and the deductible will be paid by Medicaid.<\/li>\n<li>The NPI that is used on your Medicare claim must be enrolled with Medicaid. Your crossover claims will not be processed if the NPI on your Medicare claim is not enrolled with Medicaid. In this case, Medicaid will reject the crossover claim back to Medicare and Medicare will send a notification letter of the rejection to the provider.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><em>What if I submit a claim directly to Medicaid for a patient who also has Medicare?<\/em><\/p>\n<p style=\"text-align: justify;\">If the crossover claim from <a href=\"https:\/\/www.medicare.gov\/\">Medicare<\/a> is processed first, the provider submitted claim will be denied as a duplicate claim. If the provider submitted claim is processed prior to the Medicare crossover claim, the provider submitted claim will be paid as it is today if the zero-fill indicator is included on the claim. When the crossover claim is received it will also be paid.<\/p>\n<h3 style=\"text-align: left;\">Avoiding Crossover Claim Rejections<\/h3>\n<p style=\"text-align: justify;\">If your Medicaid crossover claims are getting rejected, it may be due to the address you have on file with Medicare and Medicaid. When Medicare crosses over your claim to Medicaid these address fields are submitted: Master address, and Pay-to (or remit address) (if they are different on Medicare&#8217;s system). You can verify that you have the exact same addresses on file with both Medicare and Medicaid. If Medicaid does not have the same addresses in their file, Medicaid will reject the claim.<\/p>\n<h3 style=\"text-align: left;\">Updating Medicare\/Medicaid Enrollment Record<\/h3>\n<p style=\"text-align: justify;\"><strong>Medicare:<\/strong> If you do not have the correct addresses on file with Medicare, update your enrollment file by completing the appropriate CMS-855 form. To expedite the processing of your application, you can use Provider Enrollment, Chain, and Ownership System (PECOS).<\/p>\n<p style=\"text-align: justify;\"><strong>Medicaid:<\/strong> Updating address with Medicaid can be done in two ways:<\/p>\n<ul style=\"text-align: justify;\">\n<li style=\"text-align: left;\">Access Medicaid&#8217;s secure web portal external link, click on &#8220;Demographics&#8221; and then &#8220;Address,&#8221; to update the address.<\/li>\n<li style=\"text-align: left;\">Contact Medicaid&#8217;s provider enrollment customer service line and they will fax the appropriate paperwork to you.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Note that Medicaid requires a notarized copy of your W9, showing your new address which may be submitted via fax. You may use Medicaid&#8217;s web portal to create a fax cover sheet, which should include: Attention: Provider Enrollment. Medicaid also recommends that you add your provider ID number to all pages within your document (including the fax cover sheet).<\/p>\n<h4 style=\"text-align: justify;\">About Medical Billers and Coders<\/h4>\n<p style=\"text-align: justify;\">We are catering to more than 40 specialties,\u00a0<a href=\"https:\/\/bit.ly\/38maDq8\"><strong>Medical Billers and Coders (MBC)<\/strong><\/a>\u00a0is proficient in handling services that range from\u00a0<a href=\"https:\/\/medicalbillersandcoders.com\/revenue-management-services.aspx\">revenue cycle management<\/a>\u00a0to\u00a0<a href=\"https:\/\/www.medicalbillersandcoders.com\/ICD-10.aspx\">ICD-10<\/a>\u00a0testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.<\/p>\n<h2>FAQs<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1745913640817\"><strong class=\"schema-faq-question\">1. What is a crossover claim?<\/strong> <p class=\"schema-faq-answer\">A crossover claim is for patients eligible for both Medicare and Medicaid, where Medicare pays part of the claim, and Medicaid covers the remaining deductible or coinsurance.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1745913656490\"><strong class=\"schema-faq-question\">2. Do I need to submit claims to Medicaid for crossover patients?<\/strong> <p class=\"schema-faq-answer\">No, Medicare automatically crosses the claim over to Medicaid. Providers do not need to bill Medicaid directly, but they should check their Medicare Remittance Advice for confirmation.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1745913668543\"><strong class=\"schema-faq-question\">3. What happens if Medicare pays part of the claim but denies others?<\/strong> <p class=\"schema-faq-answer\">If Medicare denies part of the claim, the paid portions (with PR codes) will be crossed over to Medicaid. Providers must resubmit an adjustment to Medicaid to include the denied lines.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1745913679141\"><strong class=\"schema-faq-question\">4. What if my NPI is not enrolled with Medicaid?<\/strong> <p class=\"schema-faq-answer\">If your NPI is not enrolled with Medicaid, the crossover claim will be rejected, and you will receive a notification from Medicare about the rejection.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1745913688741\"><strong class=\"schema-faq-question\">5. How can I avoid crossover claim rejections?<\/strong> <p class=\"schema-faq-answer\">Ensure that the addresses on file with both Medicare and Medicaid match. If they don&#8217;t, Medicaid may reject your crossover claim.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and\/or coinsurance. A Coordination of Benefits Contractor (COBC) is used to electronically, automatically cross over claims billed to Medicaid for eligible recipients. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":12748,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[2480,12,146,147,753],"class_list":["post-12747","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-crossover-claim","tag-medical-billing-services-2","tag-medicare-2","tag-medicare-and-medicaid-services","tag-medicare-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.0 (Yoast SEO v28.0) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is the Medicare Crossover Claim?<\/title>\n<meta name=\"description\" content=\"Crossover Claim means Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and\/or coinsurance.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What is the Medicare Crossover Claim?\" \/>\n<meta property=\"og:description\" content=\"Crossover Claim means Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and\/or coinsurance.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/\" \/>\n<meta property=\"og:site_name\" content=\"Medical Billing and RCM Blogs\" \/>\n<meta property=\"article:published_time\" content=\"2021-01-18T11:21:05+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-04-29T08:01:49+00:00\" \/>\n<meta property=\"og:image\" 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What is a crossover claim?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"A crossover claim is for patients eligible for both Medicare and Medicaid, where Medicare pays part of the claim, and Medicaid covers the remaining deductible or coinsurance.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913656490","position":2,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913656490","name":"2. Do I need to submit claims to Medicaid for crossover patients?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No, Medicare automatically crosses the claim over to Medicaid. Providers do not need to bill Medicaid directly, but they should check their Medicare Remittance Advice for confirmation.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913668543","position":3,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913668543","name":"3. What happens if Medicare pays part of the claim but denies others?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"If Medicare denies part of the claim, the paid portions (with PR codes) will be crossed over to Medicaid. Providers must resubmit an adjustment to Medicaid to include the denied lines.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913679141","position":4,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913679141","name":"4. What if my NPI is not enrolled with Medicaid?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"If your NPI is not enrolled with Medicaid, the crossover claim will be rejected, and you will receive a notification from Medicare about the rejection.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913688741","position":5,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-medicare-crossover-claim\/#faq-question-1745913688741","name":"5. How can I avoid crossover claim rejections?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Ensure that the addresses on file with both Medicare and Medicaid match. 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