The Crossover Claims CBT provides an overview of the process for submitting claims and receiving reimbursement when a client has both Medicare and Medicaid.
At the conclusion of this CBT, you should be able to:
- Define “crossover claim”;
- Compare the relationship between Medicaid and Medicare;
- Understand provider requirements for provider participation in Medicaid and Medicare;
- Understand Medicare participation waivers and the Medicaid provider types that are not required to participate in Medicare;
- Understand the categories of Medicare benefits;
- Submit Medicare crossover claims;
- Understand filing deadlines for crossover claims;
- Submit required documentation; and
- Appeal a denied or adjusted crossover claim.
Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.