MSP Claim Filing Tips

  • A claim should be submitted to the primary insurer first.
  • An explanation of benefits (EOB) or payment determination from the primary insurer must accompany each paper claim submitted to Medicare.
  • Suppliers submitting Medicare Secondary Payer (MSP) claims electronically must include the primary payer paid amount, approved amount, and the obligated to accept amount.
  • If Medicare is secondary to a group health plan (GHP), Items 11 and 11a-c of the CMS-1500 claim form must be completed.
  • If the claim is due to an accident, Items 10a–c of the CMS-1500 claim form should be completed.
  • The claim should be submitted for the total charge, not the difference between a supplier's usual charge and the primary insurer's payment i.e., coinsurance. The total charge should not be reduced to reflect the Medicare or primary insurer's allowed amounts.
  • Refer to the patient responsibility (PT RESP) field on the Medicare Remittance Notice (MRN) to determine how much to bill the beneficiary. The coinsurance (COINS) and deductible (DEDUCT) fields are calculated based on the Medicare primary payment and do not apply to a secondary claim.

 

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