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
Step 2: Eligibility File EXPORT to the Coordination of Benefits Contractor (COBC)
  • 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
Step 3: Crossover Claim Files IMPORT at Clearinghouse
  • 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
Step 4: Crossover Claim Files EXPORT to Client
  • 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



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