Crossover Claim(s) definition
Crossover Claim(s) means claims for Dual Eligible Members where Medi-Cal is the secondary payer and Medicare or other health care coverage (OHC) is the Primary payor for dates of service during which the Dual Eligible Member was not assigned to one of CalOptima’s programs. “Dual Eligible Members” means Members who are eligible for both Medicare or OHC and Medi-Cal benefits.
Crossover Claim(s) has the meaning set forth in Section 4(c)(i) hereof.
Examples of Crossover Claim(s) in a sentence
Medicare Services that become a Medicaid expense due to coinsurance (True Cross-over Claims).
The Contractor MIS must process and pay Medicare Crossover Claims and adjustments.
The Medi-Cal reimbursement rates in this Contract will not apply to Crossover Claims for Dual Eligible Members.
For Crossover Claims, CalOptima will reimburse County in accordance with CalOptima Policies, Government Contracts, Medi-Cal and Medicare program requirements, and state and federal laws and regulations.