Crossover Only Enrollment FAQs
1. Who are Crossover Only providers? Crossover providers meet two conditions. The first condition is that they are enrolled in Medicare and are not enrolled in Medi-Cal. The second condition is that they have provided a service to a dual-eligible beneficiary and are seeking approval for reimbursement of that service from Medi-Cal.
2. Who is a dual-eligible beneficiary? A dual-eligible beneficiary is a beneficiary that is eligible for both Medicare and Medi-Cal.
3. How does a Crossover Only provider receive approval for reimbursement for a service provided to a dual-eligible beneficiary by Medi-Cal? If a provider is Medicare enrolled and not Medi-Cal enrolled and provides services to a beneficiary who is eligible for both Medicare and Medi-Cal, the provider may receive approval for reimbursement for services rendered to the beneficiary by completing and submitting MC 0804 to the Provider Enrollment Division. The mailing address is listed on the form.
4. Is approval for reimbursement from Medi-Cal automatic for a service provided to a dual-eligible beneficiary? No. Form MC 0804 is subject to Departmental approval. Please read the Crossover Only Provider Bulletin for more information. Please read MC 0804 form instructions carefully and thoroughly before completing.
5. If I am a provider who is both Medicare and Medi-Cal enrolled, do I need to submit a Crossover Only Provider Form MC 0804 if I provide services to a beneficiary that is both Medicare and Medi-Cal eligible? No. If you are a provider who is already enrolled in Medi-Cal, you do not need to fill out MC 0804. MC 0804 is only applicable to those providers who are not enrolled in Medi-Cal and who do not wish to be enrolled in Medi-Cal.
6. If a provider wishes to enroll in Medi-Cal do they fill out MC 0804? No. If a provider wishes to enroll in Medi-Cal, they must submit a complete application package pursuant to CCR, Title 22, Section 51000.30.