What do "crossover claims" refer to?

Crossover claims specifically relate to patients who are eligible for both Medicare and Medicaid, commonly referred to as dual-eligible beneficiaries. These claims are processed through both programs to cover different aspects of the patient's healthcare expenses. The interaction between the two systems is essential because Medicare typically pays first for services, and then Medicaid may cover additional costs that Medicare does not.

Understanding crossover claims is important for proper billing and reimbursement processes, as they ensure that both insurance programs contribute to covering the patient's medical bills appropriately. This coordination allows for comprehensive coverage and helps to minimize out-of-pocket expenses for beneficiaries. This complex relationship underlines the crucial nature of these claims in the healthcare system, especially for vulnerable populations who rely on both Medicare and Medicaid for their healthcare needs.