Manually identifying Medicare-Medicaid crossover claims for QMB (Qualified Medicare Beneficiaries) results in missed reimbursements and increased billing lag. Processing errors can also cause incorrect adjustments.
Our Approach
Speridian automated the crossover workflow to validate patient eligibility, match primary and secondary claims, and apply appropriate contractual adjustments per state Medicaid rules.
Key Features
Automated eligibility validation
from state databases
Match logic for dual-eligible
claim pairs
Contractual write-off logic
per state fee schedules
Exception-based workflow routing
Adjustment journal creation
with audit trail
Key Benefits
Eliminated manual tracking of crossover claims
99% accuracy in adjustment posting
Improved claims throughput and team productivity
Compliance with QMB billing mandates
Cloud-agnostic and infrastructure-independent, this solution integrates cleanly with leading enterprise platforms. It delivers seamless, secure scalability, free from vendor limitations.
Connect with Speridian Technologies today and see how quickly your organization can get started.
