Get Crossover Outpatient Facility Claim Type 31

Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share.

A claim billed to Medi-Cal for Medicare deductible and coinsurance is called a crossover claim.

The Medicare/Medicaid Crossover is a process where a provider or billing agent can submit one claim and have that claim be adjudicated by Medicare and Medicaid. The claim submitted to Medicare will report the provider NPI.

A permanent injunction (Charpentier v. Belshé [Coye/Kizer]) filed December 29, 1994, allows providers to rebill Medi-Cal for supplemental payment for Medicare/Medi-Cal Part B. services, excluding physician and laboratory services.

As with current crossover claims, Medi-Cal pays coinsurance and/or deductibles for both Medicare Part A and Part B services.

Cutback Ind: This field identifies medical services which are subject to a 20 percent rate reduction when performed in a hospital outpatient department or, for surgical procedures, in a surgical clinic. The cutback does not apply to an emergency room place of service.

A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered. to Medicare. If Medicare denies payment: You're responsible for paying. However, since a claim was submitted, you can appeal to Medicare.

Some people qualify for both Medicare and Medi-Cal and are “dual eligible” or Medi Medi beneficiaries. When an individual has both Medicare Parts A and B, Medicare is the primary insurance and pays for most medical care. Medi-Cal is the secondary insurance.