Medicare Crossover Claims to Medicaid

Definition of Medicare Crossover Claims

Medicare crossover claims are claims that have been approved for payment by Medicare and sent to Medicaid for payment towards the Medicare deductible and coinsurance within Medicaid program limits.

Definition of Medicaid Program Limits

Medicaid will not pay a crossover claim when it has been paid by Medicare in an amount that is the same or more than Medicaid’s rate for the specified service.
Medicaid will not pay a crossover claim when it is for a service that is not covered by the Medicaid program.

Who is an Eligible Recipient

A Medicaid recipient who is also receiving Medicare benefits is called “dually eligible.”

How Medicaid Receives Crossover Claims

After providing a service to a dually-eligible recipient, the provider sends a claim to its Medicare carrier or intermediary. After Medicare processes the claim, it sends the provider an explanation of Medicare benefits. If Medicare has approved the claim, Medicaid can pay towards the deductible and coinsurance according to Medicaid policy.
Medicare crossover claims are submitted to the Medicaid fiscal agent by one of the following methods:
• An electronic submission generated automatically by the Medicare intermediary or carrier,
• A paper submission by the provider that includes the claim and the Explanation of Medicare Benefits (EOMB), or
• Electronic claims submission by the provider.

Automated Crossover Carriers and Intermediaries

Some Medicare intermediaries and carriers have arranged to send crossover claims to Medicaid. These automated Medicare intermediaries and carriers are:
• AdminaStar Federal—Part A
• Blue Cross Blue Shield of Connecticut—Part A
• Blue Cross Blue Shield of Florida—Part A
• Blue Cross Blue Shield of Florida—Part B
• Blue Cross Blue Shield of Georgia—Part A
• Blue Cross Blue Shield of Tennessee—Part A
• Blue Cross Blue Shield of Texas—Part A• Mutual of Omaha—Part A
• Palmetto Government Benefits (also known as DMERC)—Part B
• United Government Services—Part A

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