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Handling a crossover claim (when the primary forwards it on)

Some primary payers — Medicare especially — don't just pay their share, they forward the claim on to the secondary payer for you. This is called a crossover. When it happens, submitting your own secondary claim would send the payer a duplicate. Pabau reads the crossover signal off the primary's remittance and tells you the claim was forwarded, so you can record it as handled instead of billing it again.

NOTE: The insurance billing module is available for practices in the United States and works with your connected Claim.MD account.

How you'll know a claim crossed over

When the primary payer's electronic remittance (ERA) says the claim was processed and forwarded to the next payer, Pabau keeps the claim on Paid but marks it as forwarded. On the claim, the settlement bar tells you the primary forwarded it to the secondary payer, and — instead of the usual Create secondary claim button — it offers Record as forwarded.

IMPORTANT: Don't submit a secondary claim on a crossover. The primary already sent it on; a second submission from you is a duplicate the payer has to sort out. Use Record as forwarded instead.

Recording the crossover

  • Open the paid claim. If the primary forwarded it, you'll see the crossover note and the Record as forwarded button.
  • Click Record as forwarded. Pabau marks the secondary as submitted-by-crossover and notes which carrier it went to. Nothing is uploaded to the clearinghouse — the primary already handled that.
  • The claim now reads as handled: its secondary shows as submitted on the settlement bar, so it won't sit in your Secondary due worklist as if it still needs billing.

What if the secondary doesn't pay?

A crossover is the primary's promise to forward the claim, not a guarantee the secondary pays. Give it the payer's normal turnaround. If the secondary never pays and you need to bill it yourself after all, you can still create the secondary claim from the same claim — see Submitting secondary claims in Pabau.