What is the term used for the payer that Medicare forwards the claim to after initial processing?

• A. Primary payer
• B. Alternate payer
• C. Crossover payer
• D. Secondary payer

Answer: (C)

The concept being tested is how Medicare handles claims when another payer is also involved. When Medicare processes a claim and there’s additional coverage from a secondary payer, Medicare automatically forwards the claim to that secondary payer for further processing. The term used for the payer who receives this forwarded claim is the crossover payer. This term specifically describes the recipient of Medicare’s pass-along after initial processing, not the payer who bills first or the payer who pays after the primary one. In practice, the crossover (or automatic crossover) streamlines coordination of benefits, so the secondary payer can review and pay any remaining allowed amount after Medicare’s payment.