405 IAC 1-18-2 Reimbursement of cross-over claims

Sec. 2. (a) Cross-over claims filed by providers are reimbursed as set out in this section. (b) If the Medicare payment amount for a claim exceeds or equals the Medicaid allowable amount for that claim, Medicaid reimbursement will be zero (0). (c) If the Medicaid allowable amount for a claim exceeds the Medicare payment amount for that claim, Medicaid reimbursement is the lesser of: (1) the difference between the Medicaid allowable amount minus the Medicare payment amount; or (2) the Medicare cost-sharing costs described in 42 U.S.C. 1396d(p)(3)(B) through 42 U.S.C. 1396d(p)(3)(D), if any, for the claim.