Medicare Crossover: United Healthcare Explained

Medicare CrossoverMedicare Crossover is the process by which Medicare, as the primary payer, automatically forwards Medicare Part A (hospital) and Part B (medical) including Durable Medical Equipment (DME) claims to a secondary payer for processing. It is a standard offering for most Medicare-eligible members covered under UnitedHealthcare Commercial plans. Enrollment is automatic for these members.

  • Allow 15-20 days to receive and review the Explanation of Benefits (EOB) from Medicare before filing the secondary claim to UnitedHealthcare, if required.
  • Remark code MA-18 on the EOB indicates the claim was sent by Medicare to the secondary payer. Allow an additional 15-30 days for UnitedHealthcare to receive and process the crossover claim.
  • Claims should not be sent to UnitedHealthcare that were crossed over by Medicare, as denoted by code MA-18 on the EOB. Sending another claim when one is already in our system will slow the payment process and create confusion for the member.
  • If code MA-18 is not on the EOB, the secondary claim can be filed electronically by the provider or billing entity (see COB Electronic Claim Requirements ‒ Medicare Primary on this page).
  • Allow up to 30 days after receiving the EOB before following up on the receipt of the secondary claim by UnitedHealthcare from Medicare.
  • To follow up on the receipt or status of a claim, check claim status (276/277) using your practice management system, a clearinghouse or the UnitedHealthcare Provider Portal.

To learn more about EDI in Healthcare and become a certified EDI Professional please visit our course schedule page.

Leave a Reply

Your email address will not be published.

Post Navigation