After providing a service to a dually-eligible recipient, the provider sends a claim to its Medicare carrier or intermediary. After Medicare processes the claim, it sends the provider an explanation of Medicare benefits (EOMB). If Medicare has approved the claim, Medicaid can pay towards the deductible and coinsurance according to Medicaid policy. Medicare crossover claims are submitted to the Medicaid fiscal agent by one of the following methods:
An electronic submission generated automatically by the Medicare intermediary or carrier;
A paper submission by the provider that includes the claim and the Explanation of Medicare Benefits (EOMB) also known as the
Medicare Remittance Advice (RA); or Electronic claims submission by the provider.
If a provider’s Medicare carrier or intermediary does not automatically send crossover claims to the Medicaid fiscal agent, the provider must submit Medicare crossover claims to the Medicaid fiscal agent either electronically or on paper claim forms.