Submitting Medicare Secondary Payer (MSP) Claims and Adjustments
When your dates of service fall within the Effective and Termination dates of an MSP record, the claims must acknowledge the MSP record by reporting appropriate MSP coding on your claim. In general, claims and adjustments that include MSP information must be submitted electronically using the ANSI ASC X12N 837 format.
Note: Providers that meet the small provider exception, (CMS Pub. 100-04, Ch. 24 §90), may submit paper (UB-04) claims.
For detailed instructions on billing MSP claims, including the required data elements (value codes, occurrence codes, primary insurer information, etc.) refer to the CGS 'Medicare Secondary Payer (MSP) Billing and Adjustments' quick resource tool or the ‘Medicare Secondary Payer (MSP) Billing and Adjustments’ Online tool.
Correcting MSP Claims and Adjustments
The above information also applies when you are correcting a claim that has been returned to you (RTP file, status location T B9997). Claims that are corrected out of the RTP file are considered to be submitted DDE, regardless of whether they were originally submitted electronically (5010 format). Therefore, rather than correcting a claim (from the RTP file) it must be resubmitted electronically (with the error corrected) in order to meet the electronic billing requirement.
|Two Vantage Way, Nashville, TN 37228||©2014 CGS Administrators, LLC. All Rights Reserved|