Medicare crossover definition

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

  • MHD developed an easy to use, web-based tool to adjust incorrectly billed and/or paid Medicaid and Medicare crossover claims.

  • Nevada Medicaid does not enroll providers to provide mail order delivery of pharmaceutical or durable medical equipment or gases, except those providing services to Medicare crossover recipient’s only.

  • Assessments that cannot be classified to a RUG-III group due to errors shall be excluded from both average case-mix index calculations.81.6(20) Medicare crossover claims for nursing facility services.a. Definitions.

  • UPL payments made on a state fiscal year basis should be reported in Section C of the survey.Note D - Should include other Medicare cross-over payments not included in the paid claims data reported above.

  • Topic #704Claims That Fail to Cross OverForwardHealth must be able to identify the billing provider in order to report paid or denied Medicare crossover claims information on the RA (Remittance Advice).

  • Total Pediatric Inpatient Adjustment Payment in accordance with 148.298(b):{Line 8 * Line 9} N/A* Excludes Medicare crossover days.

  • A coinsurance days claim (also known as a "Medicare crossover claim") for Medicare-allowed days If the resident is QMB-Only, a nursing home may submit only a coinsurance days claim to ForwardHealth.

  • Topic #671 Crossover ClaimsA Medicare crossover claim is a Medicare-allowed claim for a dual eligible or QMB-Only (Qualified Medicare Beneficiary-Only) member sent to ForwardHealth for payment of coinsurance, copayment, and deductible.

  • This includes, among other things, reimbursement of only Medicare crossover claims (i.e., claims with respect to “dual eligible” recipients who are covered by both Medicare and Medicaid).An application might be denied.

  • Medicare crossover claims and Medicaid managed care encounter claims are excluded.

Related to Medicare crossover

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Adult care home means any nursing facility, nursing facility for

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide items and services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Medical care facility as used in this title, means any institution, place, building or agency, whether

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Orthodontic means a type of specialist dental treatment carried out by an orthodontist that diagnoses, prevents and corrects mispositioned teeth and jaws and misaligned bite patterns.

  • Hospice patient s family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

  • Health care organization ’ means any person or en-

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • Health care facility or "facility" means hospices licensed

  • Pharmacy means prescribed drugs and medicines dispensed by a pharmacist and/or travel and allergy vaccines dispensed by a pharmacist or doctor.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Local anesthesia means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.

  • Home Health Care Agency means an agency or organization which provides a program of home health care and which:

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

  • Nuclear pharmacy means a pharmacy providing radio-pharmaceutical service.

  • Health carrier or "carrier" means a disability insurer

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Anesthesiologist means a physician granted clinical privileges to administer anesthesia.