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.
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.
Billing MSP Electronically - 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.
Definitions - The definition of MSP-specific terms are provided.
Inquiries and Solutions - View 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 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).
Payment Calculation Examples - Scenarios are provided which include the primary insurance company's payment, the provider's billed amount, Medicare's allowed amount, deductible, coinsurance and Medicare's payment.
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).
Tertiary Claims - View instructions for billing MSP claims when Medicare is the third payer - More than One Primary Payer with Different Allowed Amounts.
- CMS Coordination of Benefits & Recovery Overview
- CMS End Stage Renal Disease (ESRD) Center
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3 - MSP Provider, Physician, and Other Supplier Billing Requirements
- CMS MSP Provider Services Website
- Veterans Administration
Last Updated Sep 15, 2017
Beneficiaries are required to complete a 30 month coordination period prior to Medicare becoming their primary insurance.