405 IAC 1-18-1 - Definitions
Current through December 29, 2021
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15-13; IC 12-15-14
Sec. 1.
(a) The
definitions in this section apply throughout this rule.
(b) "Cross-over claim" means a Medicaid claim
filed on behalf of a Medicare beneficiary who is also eligible for Medicaid.
The term includes claims filed on behalf of beneficiaries who are eligible for
Medicaid in any category, including, but not limited to, qualified Medicare
beneficiaries (QMBs) and beneficiaries who are eligible for full Medicaid
coverage.
(c) "Medicaid allowable
amount" means the reimbursement rate for a Medicaid claim as determined under
state and federal law and policies. This reimbursement rate shall be the most
recent rate on file with the office of Medicaid policy and planning or its
contractor at the time a cross-over claim is processed.
(d) "Medicare payment amount" means the
amount of payment made by Medicare to the provider for a given claim. It does
not include coinsurance amounts or deductibles.
Notes
The following state regulations pages link to this page.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.