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What Is a Crossover Claim?

A crossover claim is the transfer of claim data from Medicare to those of another relevant insurer, private or public. The recipient of the information might be Medicaid, a state agency or a private insurance company.

  1. The Centers for Medicare and Medicaid Services

    • Claims are flagged, stored and then processed.

      The Centers for Medicare and Medicaid Services (CMS) has a coordination of benefits (COB) program run by the COB contractor. As Cigna explains it, "The claims that have been flagged for crossover are then stored in the contractor's processing system until the claims have completed the processing cycle and are released for payment."

    Medigap

    • The responsibilities of the COBC include claims-based Medigap crossovers. As Noridian Administrative Services explains on its website, "Medicare beneficiaries initiate the automatic transmittal of claims information by exercising their right to assign payment of Medigap as well as Medicare benefits, for the services of participating suppliers."

    Private Insurers

    • Each private insurer offering a Medigap policy is issued a coordination of benefits agreement identification number, to be used on incoming claims.

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