Florida Dual-Eligible and Crossover Claims Tip Sheet

This guide provides information on the submission of crossover claims for dual-eligible patients in Florida who are enrolled in Medicare and Humana Healthy Horizons plans. It outlines the definition of a crossover claim, which is a claim for services processed by Original Medicare and then transferred to a Humana Healthy Horizons plan for adjudication. The document details the necessary steps for claim submission, emphasizing the importance of including the Explanation of Medicare Benefits (EOMB) and ensuring all required information is present on the CMS-1500 or UB-04 forms. It also offers billing tips, such as verifying patient registration for crossover claims and the procedure for submitting claims manually if no response is received from Humana Healthy Horizons within 45 days. Additionally, it notes exceptions for certain services that require direct submission to Humana Healthy Horizons without a Medicare claim. Regular reviews of the information are mentioned, along with resources for further assistance.