Final answer:
A crossover claim is transmitted from the primary payer to the secondary payer, usually electronically. Such claims occur when a patient has more than one insurer, allowing for a seamless transition of payment responsibilities for medical services rendered.
Step-by-step explanation:
What is a Crossover Claim?
A crossover claim is a claim that is processed by a primary payer and then transmitted automatically to the secondary payer. This usually occurs in healthcare billing when a patient has more than one insurance policy. The primary payer is the insurance that must be billed first; after the primary insurer has paid its share of the costs, the crossover claim is sent to the secondary insurance to cover the remaining balance, if any.
How is a Crossover Claim Transmitted?
The transmission of crossover claims can happen electronically through coordination of benefits (COB). Once the primary payer has processed the claim, it will send the necessary information via an electronic data interchange to the secondary payer. The secondary insurer then coordinates the benefits and covers any eligible expenses, according to their policy provisions. The COB process helps prevent duplicate payments and ensures that claims are paid in the correct order of responsibility.