Beneficiaries are required to complete a 30 month coordination period prior to Medicare becoming their primary insurance.
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 - If you have MSP inquiries, including, the reporting of potential MSP situations, invalid MSP auxiliary files and general MSP questions/concerns contact the BCRC. The BCRC is the sole authority to ensure the accuracy and integrity of the MSP information contained in the CMS database/national file.
Benefits Coordination & Recovery Center (BCRC), NGHP - The BCRC's responsibility is to protect the Medicare trust fund by recovering payments Medicare made when another entity had primary payment responsibility. The BCRC identifies and recovers Medicare payments that should have been paid by another entity as the primary payer either under a Group Health Plan or as part of a Non-Group Health Plan claim which includes, but is not limited to Liability Insurance, No-Fault Insurance, and Workers' Compensation.
Capped Rental with MSP - If the primary insurance pays for the lump sum purchase of a capped rental item (except complex rehabilitative power wheelchairs), Medicare cannot make a secondary payment.
Decision Tree - This tool assists suppliers in determining primary coverage for a beneficiary.
Medigap - Medigap is a health insurance policy or other health benefit plan offered by a private entity to those persons entitled to Medicare benefits and is specifically designed to supplement Medicare benefits.
MSP Claim Filing Tips - View tips for successfully submitting a claim for Medicare Secondary Payer.
MSP Definitions - View common MSP terms and definitions.
MSP Overpayment Refunds - It is the supplier's responsibility to refund overpayments on MSP claims.
MSP Payer Types - The two-digit numeric value assigned to each MSP type, as well as a description of the MSP type is provided below in an effort to help providers identify the correct value to report on electronic claims (the MSP type is not indicated on paper claims, other than checking the appropriate box in Item 10).
MSP Payment Calculation - Medicare secondary payments are based on the higher allowable charge between the primary insurer and Medicare unless the supplier is obligated to accept the primary insurer's allowable as payment in full.
MSP Payment Calculator - Providers may enter specific amounts from the primary insurance company's Explanation of Benefits in addition to their billed amount to determine Medicare's payment (line-level, not full claim billed amount).
MSP Questionnaire Information Gathering - Prior to billing Medicare, suppliers must take an active role in the identification of MSP claims/cases.
MSP Recovery Contractor (MSPRC) - CMS has consolidated all of the functions and workloads related to Medicare Secondary Payer post-payment recoveries into one MSP recovery contract.
MSP Types - View the different types of insurances primary to Medicare.
Obligated to Accept Field (OTAF) - This is the amount the provider agreed to accept from the primary payer when the amount is less than the charges but higher than the payment amount; then a Medicare secondary payment is due to the provider.
One or Multiple Primary Payers - There may be situations where one or more than one primary insurer to Medicare makes payment on a claim.
- Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compenstation MSP Claims - MLN Matters 7355 Revised
- CMS Internet Only Manual (IOM), Medicare Secondary Payer (MSP) Manual, Publication 100-05, Chapter 3 - MSP Provider, Physician, and Other Supplier Billing Requirements
- CMS MSP for Providers, Phyisicians, other Suppliers and Billing Staff Fact Sheet
- Coordination of Benefits & Recovery Overview
- Important Reminder About MSP Laws - SE1227
Last Updated Sep 15, 2017