Skip over navigation

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.

Topic Brief Description
Benefits Coordination & Recovery Contractor (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 Benefits Coordination & Recovery Center (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 Contractor (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.
Billing MSP Electronically This link takes you to an external website.

The Noridian Electronic Data Interchange (EDI) Support Services (EDISS) team has prepared a step-by-step 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.

  • PC-ACE Pro32 is an option available to providers whose software will not electronically submit MSP claims. It is a free/low cost billing software that is HIPAA compliant and supported by Noridian Electronic Data Interchange (EDI) Support Services (EDISS). It is available to download free of charge from http://www.edissweb.com/ This link takes you to an external website. . PC-ACE Pro32 provides its users a direct method for electronic claim submission and electronic remittance advice receipt.
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 The definition of MSP-specific terms.
Form Locators Form locators required for Billing MSP Claims
Inquiries and Solutions The following are inquiries and solutions related to Medicare Secondary Payer (MSP) claim processing.
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.
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).

 

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.

Resources

Last Updated Nov 08, 2016

ESRD 30 Month Coordination Period Calculator



 

 

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