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Tertiary Claims - JF Part B

MSP Tertiary Claims

In a Medicare Secondary Payer (MSP) situation, Medicare uses the primary payers allowed and paid amounts to calculate the supplemental amount that may be paid by Medicare. In some cases, a beneficiary may be covered by more than one primary payer. Before Medicare can process a tertiary claim, the claim must be processed by the other payers. The allowed amount by both primary payers might differ.

Due to limitations with electronic claims transaction formats adopted for national use, it is not possible to submit these types of claims electronically to Medicare while including all the required information in certain situations involving multiple payers.

How to Submit Tertiary Claims

  • Provider will submit claim electronically, as Medicare primary, to Medicare
    • Medicare will deny claim for MSP information
  • Once claim has denied, provider will submit a completed MSP form and include both primary payers' Remittance Advices (RAs)
    • Medicare will reprocess claim

See the MSP form on the Forms webpage.

See Education on Demand Tutorials for audio presentation on MSP Conditional Payments and Tertiary Claims.


Last Updated Fri, 30 Oct 2020 15:20:58 +0000