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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 - 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 will take 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.

Definitions - View definition of MSP-specific terms.

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 Calculation Examples - View scenarios 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.

Resources

Last Updated Oct 23, 2017



 

 

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