Crossover Claim

• Primary insurance processes the claim and forwards the claim to secondary insurance along with a copy of the EOB. Secondary insurance will process the claim based on the primary EOB. The process of sending the primary EOB along with the claim to secondary insurance is known as a Crossover claim.

• Medicare insurance crossovers the claim automatically to secondary insurance if it has secondary insurance information.

• To verify whether a claim is forwarded to secondary insurance or not, you can check Medicare EOB/Remittance. In a Medicare EOB/remittance, the insurance name is mentioned to which the claim is forwarded. Also, you can look for the MA18 remark code in the EOB/Remittance to identify the crossover claim.

• If the claim is already forwarded to the secondary payer then do not resubmit the claim to the secondary payer or else it would be denied for a duplicate.

• Sometimes, there would be a scenario where crossover claims are already denied by secondary insurance and when a call is made to secondary insurance then insurance rep says that information is missing or invalid in the claim form whereas when you check the claim form in the system, information is present or correct in the claim form. In such cases, the claim can be resubmitted.