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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.

Definitions - View definitions of MSP-specific terms

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

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. View details.

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

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).

Payment Calculation Examples - 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.

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 Oct 23, 2017



 

 

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