Crossover claim
A crossover claim is a claim automatically forwarded from a primary payer (typically Medicare) to a secondary payer (often Medicaid) so the secondary can adjudicate what remains.
Updated
A crossover claim is a claim that, after the primary payer adjudicates and pays, is automatically transmitted to a secondary payer for that payer to process the remaining balance. The most common arrangement is Medicare-to-Medicaid crossover for beneficiaries eligible for both programs (dual-eligible), where Medicare's remittance is forwarded to the state Medicaid program.
The crossover is configured at the payer level through agreements and beneficiary enrollment, not filed manually per claim. When it is in place, the provider does not separately submit to the secondary; when it is not, the secondary balance must be billed manually, and a claim billed to the wrong payer first can still fail even if the eventual balance is correct.
In practice
Whether a crossover is active affects which payer a claim is sent to first and whether a separate secondary submission is needed. For dual-eligible beneficiaries the Medicare-to-Medicaid crossover is usual, but state-specific rules and supplemental coverage can change the path, so confirming the coordination order and crossover status up front avoids claims that pend or deny for routing reasons.
Commonly confused with
- Coordination of benefits: Coordination of benefits determines which payer is primary and which is secondary; a crossover is the automatic transmission of an adjudicated claim to the secondary once the primary has paid.
- Medicaid as payer of last resort: Medicaid is generally the payer of last resort, which is why Medicare-to-Medicaid crossover exists; the crossover implements that legal secondary position rather than contradicting it.