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 Summary
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.
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.
  • Admission Questions to Ask Medicare Beneficiaries [PDF] - Providers may complete this by asking a beneficiary each question at each inpatient and outpatient admission. It can be used as a guide to help identify other payers that may be primary to Medicare and will help identify MSP situations. Complete in sequence. Instructions follow questions to facilitate transition between questions and will direct patient to next appropriate question to determine MSP situations.
  • MSP [PDF] - Providers may complete this for MSP inquiries or adjustments (canceling or adjusting a previous claim submission) pertaining to primary or secondary payment of claims. Do not use for new claim submissions or to submit a refund on a claim Medicare has processed.
  • MSP Voluntary Checks [PDF] – Providers may complete and include with each unsolicited/voluntary refund check pertaining to claim processed as MSP.
MSP Payer Type and Codes 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).
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.
MSP Definitions The definition of MSP-specific terms are provided.
Billing MSP Electronically This link takes you to an external website. The Noridian Electronic Data Interchange (EDI) Support Services 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.
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 Payment Calculation Examples Scenarios are provided which include the primary insurance company's payment, the provider's billed amoutn, Medicare's allowed amount, deductible, coinsurance and Medicare's payment.
MSP Tertiary Claims View instructions for billing MSP claims when Medicare is the third payer - More than One Primary Payer with Different Allowed Amounts.
Inquiries and Solutions The following are inquiries and solutions related to Medicare Secondary Payer (MSP) claim processing.



Last Updated Aug 19, 2016

ESRD 30 Month Coordination Period Calculator



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