Crossover and Electronic Filling- Medical Billing

Cross Over :

A situation whereby gaps in coverage for the medical expenses for a Medicare Beneficiary are forwarded by the Medicare contractor to the Patient's medigap insurer for payment. Crossover applies only incase of Medicare, medigap and Medicaid plans. Medicare itself transfer the claims to the secondary insurance is called Automatic crossover. even few commercial insurance also doing crossover for the same group plans example BCBS, For Crossover patient must update the COB information with both primary and secondary insurance.

Electronic Filling:

It is one that is submitted via electronic format not that traditional paper format

National Standard Format (NSF)

It is a format used by the government.

It is a rigid format with 320 bytes.

American National Standard Institution (ANSI)

It is a format used by the private institutions with 132 bytes

It is flexible one.

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What is QMB / MQMB stands for?

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Medical Billing

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