Simple, Convenient Process

Medicare Crossover Clearinghouse Process

Step 1: Eligibility File IMPORT at Clearinghouse

• You transmit your Medicare Supplement, COB or Medigap customer eligibility files to us on a regularly scheduled basis
• Every file is scrubbed at syntax and field levels to ensure accuracy and compatibility with Medicare processing systems
• We remove duplicate records and other beneficiary records with errors prior to submission to the COBC
• Our Web-based Eligibility File Summary Report is available on a weekly basis via the Internet to provide you with the information needed to make corrections in your system

• We prepare eligibility files for submission to the COBC
• We transmit your eligibility data each week to ensure use of the most current beneficiary information

• We validate Medicare claim files at file and field levels
• We remove duplicate claims, so you don't pay twice for the same claim
• Our Web-based Changed HIC Number Report is available on a weekly basis via the Internet to provide you with a listing of eligibility records identified during claims processing with a changed Health Insurance Claim (HIC) number to be updated in your system

• Claim files are customized to meet your specific business requirements designed to enhance claim throughput
• We transmit one Part A and one Part B claim file to you for auto-adjudication and work with you to determine the frequency to send your files
• Medicare Crossover Clearinghouse offers Web-based reports to help you monitor your company's crossover claims transmissions. Our Daily Claims Transmission Report is available on a daily basis via the Intranet to provide you with an explanation of the transmitted claim files categorized by Medicare contractor. Our Monthly Claim Files Summary Report provides a monthly summation of transmitted claim files
• You receive one comprehensive invoice from us each month that incorporates the mandated CMS fees