What is a crossover claim?

A crossover claim refers to the process in which a healthcare claim is initially submitted to one insurance provider, such as Medicare, the primary payer, and then automatically forwarded to a secondary insurance provider for consideration of additional payment. This scenario occurs when an individual has both primary and secondary insurance coverage. The primary insurer processes the claim first, and any remaining balances eligible for coverage are sent directly to the secondary insurer. This mechanism streamlines the billing process for both providers and patients, ensuring that the individual receives appropriate coverage for their healthcare services.

The other options do not align with the definition of a crossover claim. Submitting a claim solely to Medicare does not cover the aspect of having dual coverage, and denying claims does not pertain to the process of crossover claims. Additionally, claims concerning only emergency services do not specifically define a crossover claim either, as crossover claims can encompass a wide range of healthcare services beyond emergencies.