A Medicare/Medicaid crossover claim is a claim that involves coordination between which programs?

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Multiple Choice

A Medicare/Medicaid crossover claim is a claim that involves coordination between which programs?

A Medicare/Medicaid crossover claim involves coordination between two programs: Medicare and Medicaid. For dual-eligible individuals, Medicare serves as the primary payer for covered services, and the claim is automatically forwarded to Medicaid to handle secondary payment as allowed by state rules. This seamless handoff ensures that services are billed across both programs to maximize coverage. Choices involving only Medicare, only Medicaid, or private insurance don’t describe this two-program coordination, which is the hallmark of a crossover claim.

A Medicare/Medicaid crossover claim involves coordination between two programs: Medicare and Medicaid. For dual-eligible individuals, Medicare serves as the primary payer for covered services, and the claim is automatically forwarded to Medicaid to handle secondary payment as allowed by state rules. This seamless handoff ensures that services are billed across both programs to maximize coverage. Choices involving only Medicare, only Medicaid, or private insurance don’t describe this two-program coordination, which is the hallmark of a crossover claim.

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