Medicare Secondary Payer (MSP) - JA DME
Medicare Secondary Payer (MSP)
Medicare Secondary Payer (MSP) is the term used to describe when another payer is responsible for paying a beneficiary's claims before Medicare pays. Noridian protects and preserves the Medicare Trust Fund by ensuring that Medicare benefits are coordinated with all other appropriate payers and Medicare pays only when and what it should pay.
Benefits Coordination & Recovery Center (BCRC), GHP - View crossover claim related information
BCRC, NGHP - View situations when a supplier should contact the BCRC
Capped Rental with MSP - If primary insurance pays for lump sum purchase of a capped rental item (except complex rehabilitative power wheelchairs), Medicare cannot make a secondary payment. View details
MSP Claim Filing Tips - View tips for successfully submitting a claim for MSP
MSP Definitions - View common MSP terms and definitions
MSP Types - View a list of MSP types and definitions
MSP Payment Calculation Examples - View information including calculation and descriptions of Allowed Amount, Paid Amount and OTAF information from Explanation of Benefits (EOB)
Obligated to Accept Field (OTAF) - View an explanation of how to determine OTAF
One or Multiple Primary Payers - There may be situations where one or more than one primary insurer to Medicare makes payment on a claim. View details
Resources
- CMS Coordination of Benefits & Recovery Overview
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3 - MSP Provider, Physician, and Other Supplier Billing Requirements
- CMS Change Request (CR) 7355 - Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compensation MSP Claims
- CMS Medicare Learning Network (MLN) Matters Special Edition (SE) 21002 - Billing for Services when Medicare is a Secondary Payer
- CMS Medicare Learning Network (MLN) Matters (MM) 12765 - Significant Updates to Internet Only Manual (IOM) Publication (Pub.) 100-05 Medicare Secondary Payer (MSP) Manual, Chapter 5
- Medicare secondary Payer: Don’t Deny Services & Bill Correctly
