Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 18 - Reimbursement of Medicare Cross-Over Claims
Section 18-2 - Reimbursement of cross-over claims
Universal Citation: 405 IN Admin Code 18-2
Current through March 20, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15-14
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.
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