Helpful Guide - Crossover Claims

A crossover claim is a claim that is forwarded to the secondary insurance by the primary insurance.

The secondary claim will not need to be created from the patient's ledger in MacPractice because your patient's primary insurance will create the secondary claim for you. A crossover claim in MacPractice is a dummy, placeholder claim you can leave in your ledger so that you can keep track of the secondary coverage.

You may want to create crossover claims for many reasons, mainly because you will still be expecting payment to come from the secondary insurance. Having a crossover claim in your ledger will allow you to apply the secondary payment to charges associated with this claim, and will also leave the portion in the Insurance portion after your primary claim is paid. Crossover claims will also appear in your Outstanding Insurance Claims report so that you can follow up with the secondary insurance and follow through to make sure you receive payment from the secondary. Crossover claims must be set up per patient with the primary insurance company. If the patient is not set up a crossover claim will not be sent to the secondary insurances. The management of crossover claims regarding payment and if the secondary payer receives the claim is outside of MacPractice's support boundaries. It is the office's responsibility to manage crossover claims.

In the Insurance Claim Creation Window, check the Also print cross-over claim to: box, and select the secondary insurance in the menu. This will generate a crossover claim with the primary claim in order to apply the secondary payment to the Ledger as it arrives.

If a crossover claim was not created in MacPractice and the secondary insurance pays before the primary, select the primary claim on the patient's ledger and select New Insurance Payment from the Payments menu. Note: this can also be done from the payment window in the ERA manager.

Open

In the payment window, select the secondary insurance in the Payment From menu. "Crossover Payment" will display below the menu once the secondary Insurance is selected. Add the payment information and click OK. A crossover claim will be posted to the Ledger along with this secondary payment.

Open

Preferences - Show Cross-Overs in eClaims

In MacPractice Preferences under the Claims option, there is a preference to Show Cross-Overs in eClaims. With this preference enabled it allows the user to view and organize any available cross-over claims within the various bins (invalid, Ready, Sent, Accepted, Rejected, Paid/Closed, Archived) of the eClaims ability. Since a cross-over claim is considered a 'dummy' claim within the MacPractice software, this is a claim that is used for tracking purposes or for use with an insurance payment from a secondary insurance carrier. That being said any cross-over claims that appear within the eClaims ability, regardless of bin, CANNOT be sent as an electronic claim. This is again because a cross-over claim is a claim that the insurance carrier would have forwarded to a secondary payer for further processing. MacPractice recommends that this preference be unchecked to improve clarity and reduce confusion in the eClaims ability. 

Open