Where can crossover payers be configured?

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Multiple Choice

Where can crossover payers be configured?

Crossover payers are set up by using both the primary payer’s master files at the payer level and at the benefit-plan level. The Payer (EPM) master file defines the payer’s identity and whether crossovers are applicable, while the Benefit Plan (EPP) master file defines how crossover rules apply for each plan under that payer, including which secondary payer to use and the COB logic. Together, they ensure the system knows, for a given claim, when and how to route and process a crossover to the appropriate secondary payer. The Claims Audit Log is only for reviewing processing history, not for configuring crossover behavior, and configuring only one file would miss either the payer-wide or plan-specific rules.

Crossover payers are set up by using both the primary payer’s master files at the payer level and at the benefit-plan level. The Payer (EPM) master file defines the payer’s identity and whether crossovers are applicable, while the Benefit Plan (EPP) master file defines how crossover rules apply for each plan under that payer, including which secondary payer to use and the COB logic. Together, they ensure the system knows, for a given claim, when and how to route and process a crossover to the appropriate secondary payer. The Claims Audit Log is only for reviewing processing history, not for configuring crossover behavior, and configuring only one file would miss either the payer-wide or plan-specific rules.

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