1. What is meant by the crossover payment?
When Medicaid providers submit claims to Medicare for Medicare/Medicaid
beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or
co-pay amount and then automatically forward the claim to Medicaid. Providers
will NO longer need to bill Medicaid separately for the Medicare deductible,
coinsurance or co-pay amounts.
2. How will the crossover process work?
New York State Medicaid will receive Medicare crossover claims from the
Coordination of Benefits Contractor (COBC), Group Health Inc. (GHI). The
various Medicare payers across the State will all transmit paid claims for
Medicare/Medicaid beneficiaries to GHI. GHI will transmit the claims to eMedNY.
How will I know if my Medicare claims were crossed over to Medicaid?
Your Medicare remittance will have an indicator that will show the claim was an
automatic cross over to Medicaid. When the indicator appears on the Medicare
remittance you will not bill Medicaid for those clients
Will Medicare release the Medicare EOMB to the providers before the claim is
crossed over to eMedNY?
The crossover will occur at the same time the Medicare EOMB is released.
Therefore the provider will see the Medicare EOMB before they see the
Medicaid remittance or the crossover payments from eMedNY.
