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What Is a Crossover Claim in Texas?

A crossover claim in Texas is the process wherein a medical claim is sent by Medicare to Medicaid, a state agency or a private insurance company. Like a traditional medical insurance claim, crossover claims are processed to facilitate medical expense payments. A crossover claim also pays the insurance deductible if not paid by Medicare.

  1. Function

    • Crossover claims involve completing a medical service transaction, if Medicare or Medicaid insurance is involved. Medicare contractors are notified through one of two methods if a crossover claim is necessary, either through a coordination of benefits agreement crossover or through the Medigap claim-based crossover.

    Requirements

    • In Texas, inpatient and outpatient crossover claims must be submitted in paper form. Providers must use Crossover Claim Types 31 and 50 templates for claims. These two forms are not federal government forms but they are required Medicaid crossover claim forms for the state of Texas.

    Considerations

    • The Balanced Budget Act of 1997 allows the Texas Department of Health to limit the Medicare Part A coinsurance for a crossover claim. This is only allowable if the Medicare payment amount is greater than or equal to the Medicaid payment amount.

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