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 - 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.
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).
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.
- 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
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3 - MSP Provider, Physician, and Other Supplier Billing Requirements
Last Updated Sep 15, 2017
Beneficiaries are required to complete a 30 month coordination period prior to Medicare becoming their primary insurance.