Crossover Payments

The Division of Medicaid and Health Financing (DMHF) is submitting a change to the Medicaid State Plan through "Attachment 4.19-B, SPA 13-023-UT Crossover Payments". The purpose of this change is to clarify that Medicaid, as a payor of last resort, utilizes third-party payment methodology for crossover claims of Medicare beneficiaries.

This amendment, therefore, clarifies that Medicaid pays only for a patient's liability on a crossover claim, and will only pay the lower of the allowed Medicaid payment rate less the amounts paid by Medicare and other payors, or the Medicare co-insurance and deductible.

DMHF does not expect any annual costs or expenditures to result from this clarification.

A copy of this change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, P.O. Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of this change are also available at local county health department offices.