Medicare crossover

Medicare crossover is a national process which passes eligibility information between insurers and Medicare’s Coordination of Benefits Contractor (COBC). As part of this process, the insurers match eligibility information with the COBCs for purposes of Medicare claims matching. In order for Medicare crossover to work, the member’s HICN (Medicare’s beneficiary number) must be in our system. Medicare will not cross over the claim to Priority Health without it. If you have identified claims that have not crossed over from Medicare, you can forward the member's HICN to your provider account coordinator (PAC).

As a reminder, Priority Health does not allow mid-level providers (NP, PA) to bill directly; claims must be billed by a participating supervising provider.

Visit cms.gov for additional information.

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