Medicare crossover definition

Medicare crossover means a claim involving a client who is eligible for both medicare benefits and medicaid.
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Examples of Medicare crossover in a sentence

  • For MSC+ this includes MCO payment for Medicare crossover claims.

  • This requirement applies to Medicare cross-over claims in addition to the other claims where a third party paid a portion of the claim.

  • Related to Medicare crossover claims, CONTRACTOR payments to NFs after payments by Medicare or a Medicare Advantage Plan cannot be less than the sum of the co-insurance, deductible, and copayment amounts calculated by Medicare or the Medicare Advantage Plan, less any applicable Member pay amount.

  • Submit To: Kentucky Department for Medicaid Services Reports the Medicare crossover claims that were denied during the reporting period because the claim was submitted without first having been submitted to Medicare for payment.

  • HMO A counts 2,000 outpatient qualifying claims paid in May (excluding Medicare crossover claims and claims paid for Childless Adult (CLA) Plan members) to five eligible hospitals.

  • The provider agrees that all original Medicaid primary claims must be received by the Department within 180 days from the date the service was provided, all original Medicare crossover claims must be received by the Department within 180 days from the date of the Medicare Explanation of Benefits (EOB), and all original Medicaid secondary/tertiary claims (excludes Medicare crossovers) must be received by the Department within 365 days from the date the service was provided.

  • HMO A counts 2,000 outpatient qualifying claims paid in May (excluding Medicare crossover claims and claims paid for Childless Adult (CLA) Plan members) to five eligible CAH(s).

  • If a Contractor's enrollee is hospitalized or in a nursing facility for rehabilitation, then the Contractor is responsible for their Medicare crossover claims in addition to case management, and may receive capitation for said month(s).

  • Interface with Medicare contractors to exchange eligibility information and to receive Medicare crossover claims, if applicable.

  • Services provided to Medicaid beneficiaries, who qualify also as Medicare crossover beneficiaries, through such subcontracts shall not be eligible for reimbursement by the Department.