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.
MSP claims are submitted using the ANSI ASC X12N 837 format, or by entering the claim directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE). Change Request (CR) 8486, effective for claims received on or after January 1, 2016, implemented changes that allow providers to submit MSP claims via FISS DDE. If you need access to FISS in order to enter claims/adjustments via FISS DDE, contact the CGS EDI department at 1.877.299.4500 (select Option 2).
Submitting MSP Claims via FISS DDE
If you submit an MSP claim via FISS DDE, claim adjustment segment (CAS) information must be reported on the “MSP Payment Information” screen (MAP1719), which is accessed from Claim Page 03 by pressing F11. This is in addition to the normal MSP coding information.
The CAS information associated with the primary payer’s claim determination is found on the primary payer’s 835 remittance advice. This information is entered on the “MSP Payment Information” screen, which accommodates up to 20 entries for primary payer 1, and 20 entries for primary payer 2 (if there is one). Refer to the following field name and description for additional information.
Press F6 to access the “MSP Payment Information” screen for primary payer 2 (if there is one).
Correcting MSP Claims and Adjustments
Return to Provider (RTP): MSP claims may be corrected out of the RTP file (status/location T B9997). However, providers must ensure that claim adjustment segment (CAS) information is reported on the “MSP Payment Information” screen (MAP1719), accessed from Claim Page 03 by pressing F11.
Adjustments: Providers may submit adjustments to MSP claims via 5010 or FISS DDE. However, if using FISS DDE, as with claims in RTP, providers must ensure the MSP information is entered on the “MSP Payment Information” screen.
|Two Vantage Way, Nashville, TN 37228||©2015 CGS Administrators, LLC. All Rights Reserved|