This training provides information and scenarios on how to submit claims for reimbursement when a client is dual eligible for both Medicare and Medicaid benefits.

This training has been designed to give you the most up-to-date information as of the publication date. It is your responsibility to regularly review the current Texas Medicaid Provider Procedures Manual (TMPPM) and all updated information as it is published on the Texas Medicaid & Healthcare Partnership (TMHP) website at

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This training:

  • Defines three parts of Medicare: A, B, and C.
  • Explains the differences between Qualified Medicare Beneficiary (QMB) and Medicaid Qualified Medicare Beneficiary (MQMB) clients.
  • Describes how to submit Medicare crossover claims.
  • Provides steps to appeal a denied or adjusted crossover claim.