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.

Resources available regarding MSP are available below.

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.
Benefits Coordination & Recovery Center (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.
  • Medicare Secondary Payer Form [PDF] - May be used for MSP inquiries or adjustments (canceling or adjusting a previous claim submission) pertaining to Primary or Secondary payment of claims. It cannot be used for new claim submissions or to submit a refund on a claim Medicare has processed.
  • MSP Refund Form [PDF] - This or a similar document containing the following information, should accompany every unsolicited/voluntary refund check pertaining to a claim processed as MSP.
  • Admission Questions to Ask Medicare Beneficiaries [PDF] - The questionnaire contains questions that can be used to ask Medicare beneficiaries upon each inpatient and outpatient admission. Providers may use this as a guide to help identify other payers that may be primary to Medicare.This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations. If you choose to use this questionnaire, note that it was developed to be used in sequence. Instructions are listed after the questions to facilitate transition between questions. The instructions will direct the patient to the next appropriate question to determine MSP situations.
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.
Inquiries and Solutions The following are inquiries and solutions related to Medicare Secondary Payer (MSP) claim processing.


Last Updated Jul 16, 2015