One or Multiple Primary Payers

1. Medicare is Secondary Payer Following One Primary Payer

There are situations where one primary payer pays on a Medicare Part B claim and Medicare may make a secondary payment on the claim. Providers must use the appropriate loops and segments to identify the other payer paid amount, allowed amount, and the obligated to accept payment in full amount on the 5010A1.

Primary Payer Paid Amount

For line level services, physicians and suppliers must indicate the primary payer paid amount for that service line in loop ID 2430 SVD02 of the 5010A1.

For claim level information, physicians and suppliers must indicate the other payer paid amount for that claim in loop ID 2320 CAS03, CAS06, CAS09, CAS12, CAS15, CAS18 of the 837

2. Medicare is Secondary Payer Following Two Primary Payers

Submission of Hardcopy MSP Claims with Multiple Primary Payers

There may be situations where more than one primary insurer to Medicare makes payment on a claim; for example, an employer group health plan makes a primary payment for a service and, subsequently, another group health plan also makes a primary payment for the same service. Claims with multiple primary payers cannot be sent electronically to Medicare. A hardcopy claim must be submitted on Form CMS-1500. Physicians and suppliers must attach the other payers' explanation of benefits (EOB), or remittance advice (RA), to the claim when sending it to Medicare for processing.

Last Updated Wed, 28 Jun 2017 14:26:07 +0000