MEDIGAP AND CROSSOVER

Both Medigap and Crossover are supplemental insurance provisions that allow providers to send a claim to Medicare B and the supplemental insurance company (Trading Partner) in one claim submission. Medigap information is submitted in Item 9 on the CMS-1500 claim form, while Crossover is an automatic process.

MEDIGAP is a benefit for participating physicians and suppliers only. Neither the provider nor the beneficiary needs to file a secondary claim if the supplemental insurance company qualifies as a "Medigap" plan and if the party that submits the claim supplies certain information about the Medigap policy. Please note, it is the responsibility of the participating provider to provide this information in Item 9 to Medicare.

CROSSOVER is an automatic process that sends an electronic Medicare Summary Notice (MSN) to a private supplemental health insurance company for both participating and non-participating providers. Crossover insurers contract with Medicare and in turn, Medicare supplies them with the information necessary to process the supplemental benefits. The private company may then pay an additional amount after Medicare has processed the claim. Since Crossover occurs electronically, the private insurer receives an electronic record instead of a paper claim. For Crossover, there is no responsibility on the part of the participating provider. All transactions that occur do so completely between WPS and the Crossover Insurance only.

The following Website contains a listing of current Trading Partners:
http://www.cms.hhs.gov/COBAgreement/Downloads/Contacts.pdf


What is the difference between Medigap and Crossover?

Answer:
Crossover is an automatic claim filing service provided by Medicare Contractors to forward claim and payment information to a patient's supplemental insurance company. Crossover is generated by a contractual arrangement with the supplemental insurer.

Medigap is a health insurance policy or other health benefit plan offered by a private entity to patients entitled to Medicare benefits. Medicare payment information is forwarded to the Medigap insurer based on information submitted on the patient’s claim.