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:

ELGA Page 09 (if MSP record exists) and ELGH Page 04
Systems that include screens with specific MSP information for a beneficiary. For information how to access or read the MSP screens, refer to the Checking Beneficiary Eligibility section of the FISS Reference Guide.

Billing and Medicare Secondary Payer
Use this flow chart 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 involved such as working aged, disability, no-fault liability, worker’s compensation, black lung, veterans administration, and Group Health Plan (GHP) Primary for 30-Month End Stage Renal Disease (ESRD).

MSP – Guidelines and Resources for Medicare Secondary Payer
A variety of MSP topics, including links to access specific CMS resources and manuals

MSP Adjustments
A table used to determine how to correct a claim or submit an adjustment when your claim was paid or denied incorrectly because of an MSP record.

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.

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.

Submitting Claims to Medicare When There Is an Accident Medicare Secondary Payer Record on the Common Working File

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