What Medicare crossover means
When Medicare is primary, it processes the claim before a secondary plan determines what it may owe. CMS’s Coordination of Benefits Agreement (COBA) supports electronic transfer of eligible Medicare claim information to participating secondary payers. CMS says an agreement must be in place for automatic crossover, and eligibility information must match its records.
That means a practice should not assume every Medicare claim will cross over or that the secondary plan will pay the remaining balance. Crossover transmits claim information; it does not establish the secondary benefit or guarantee payment.
What to check after Medicare processes the claim
Review the Medicare remittance advice for crossover or forwarding information. If the secondary plan does not receive the claim, confirm that the other coverage is current and that the plan has the information needed to match the member and claim. Then follow that plan’s instructions for a separate submission and any required records.
Keep the primary adjudication details with the follow-up. The secondary plan applies its own coverage, filing, and documentation requirements; the patient may also have cost sharing that the secondary plan does not pay.
If the claim is still missing
Check the remittance, contact the secondary payer through its provider channel, and document whether it needs a separate claim, correction, or additional information. Use the payer’s stated process and deadlines rather than assuming a universal crossover delay.
Read CMS’s Coordination of Benefits overview and COBA agreement information for the limits of Medicare’s electronic crossover process. This is general billing guidance, not a promise of processing or payment.