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Medicare Secondary Payer (MSP)

MSP is the term used to describe when another payer is responsible for paying a beneficiary's claims before Medicare pays.

Benefits Coordination & Recovery Contractor (BCRC), GHP - View crossover claim related information.

BCRC, NGHP - View when to contact the BCRC and what they are unable to assist with.

Billing MSP Electronically This link takes you to an external website. - View the Noridian Electronic Data Interchange (EDI) Support Services (EDISS) guide that illustrates how to properly submit a claim and reference the primary payer's information when submitting a claim to Medicare as the secondary payer.

Calculation Examples on Explanation of Benefits - View examples of different primary EOBs and how to calculate specific fields that determine allowed amount, patient responsibility and Obligated to Accept Payment in Full (OTAF) amount for MSP claims.

Definitions - View definitions of MSP-specific terms

Form Locators - View form locators required for billing MSP claims.

Obligated to Accept Field (OTAF) - View OTAF related details.

Payer Types - View the two-digit numeric values assigned to each MSP type and the description of each.

Notes

  • Effective January 1, 2016, per CMS Change Request (CR) 8486, providers may submit, correct, adjust and cancel Part A MSP claims in DDE
  • Providers can enter up to 20 CARC codes and dollar amounts into DDE. Go to page three and then press PF11
  • For instructions on using the Claim Adjustment Segment (CAS) for Part A MSP CMS-1450 Paper Claims, DDE and 837 Institutional Claims Transactions, see CMS CR8486 This link takes you to an external website.

Resource

Last Updated May 26, 2017



 

 

Beneficiaries are required to complete a 30 month coordination period prior to Medicare becoming their primary insurance.