Medicare Secondary Payer (MSP)

Medicare Secondary Payer Manual (CMS Pub 100-05)

Medicare is a secondary payer when the beneficiary is covered by group insurance, Workers' Compensation, Veterans Administration, or if other third-party liability applies.  Use the following resources to assist in determining when Medicare is secondary and for submitting MSP claims and adjustments:

Cahaba Resources

Checking Beneficiary Eligibility
Refer to this section of the FISS Reference Guide to research the ELGA page 09 and ELGH page 04 for specific MSP information (if an MSP record exists) for a beneficiary.

Medicare Secondary Payer Frequently Asked Questions
Refer to this resource to find answers to frequently asked questions about billing MSP claims or adjustments.

Billing and Medicare Secondary Payer Quick Reference Tool
Use this resource to determine if Medicare is secondary and for instructions on how to submit an MSP claim to Medicare, depending on the type of primary insurance.

• Home Health Prospective Payment System (HH PPS) Treatment Authorization Code
  Home health agencies (HHAs) that submit final claims for services paid under the HH PPS for a Medicare secondary or conditional payment should be aware that the Claim-OASIS Matching Key code must be entered in the second TREAT AUTH CODE (form locator 63 on the UB-04 claim form) field when Medicare is not the primary payer.  If Medicare is the tertiary payer, this information must be entered in the third TREAT AUTH CODE field.  When the Claim-OASIS Matching Key code is invalid or submitted on the wrong line, the claim will be sent to the provider’s Return to Provider (RTP) file for correction with reason code 30720.  For more information on the Claim-OASIS Matching Key code, please see the information on the Claim Page 05 — Entering a RAP or Claim Web page.

Submitting Medicare Secondary Payer (MSP) Claims and Adjustments
This portion of Cahaba’s Web site provides information about CMS requirements and limitations related to submitting MSP claims and adjustments, and requesting Medicare conditional payments.

MSP Adjustments
Determine how to submit an adjustment when your claim was paid or denied incorrectly because of an MSP record.  

Black Lung (BL) Program
Cahaba’s Federal Black Lung (BL) Program Web page provides information about billing Medicare for beneficiary’s who are covered by the Federal BL Program.

Contact Cahaba with questions about:

• Medicare claim/service denials and adjustments.
• How to bill for payment.
• Claims processing for primary or secondary payment.
• Returning inappropriate Medicare payment.

Note: Suspended claims/adjustments with Medicare Secondary Payer (MSP) information often requires Medicare staff intervention and may be suspended for more than 60 days.  Providers may call the appropriate Provider Contact Center if their claims containing MSP information have been in the same “S MXXXX” status/location for longer than 60 days.

 

Centers for Medicare & Medicaid Services (CMS) MSP Resources

Medicare Secondary Payer Fact Sheet
This fact sheet provides a general overview of the MSP provisions for individuals involved in the admission and billing procedures in home health and hospice settings. 

Medicare and Other Health Benefits: Your Guide to Who Pays First
This Guide explains how Medicare works with other kinds of insurance or coverage and who should pay your bills first.

Other Insurer Intake Tool
A questionnaire used to help determine if Medicare is primary or secondary upon each inpatient or outpatient admission. 

MSP - Guidelines and Resources for Medicare Secondary Payer
A list of MSP topics and links that access specific CMS resources and manuals

Contact the Coordination of Benefits Contractor (COBC) to:

• Report other insurance coverage information.
• Report or provide updated information on a liability, auto/no-fault, or workers compensation case.
• Ask general Medicare Secondary Payer (MSP) questions/concerns.
• Ask questions regarding Medicare Secondary Development letters and questionnaires.

Page last updated: May 18, 2010

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