Skip to Main Content

Print | Bookmark | Email | Font Size: + |

Medicare Secondary Payer (MSP) Overview

Medicare Secondary Payer Manual (CMS Pub. 100-05)External Website

Medicare is a secondary payer when the beneficiary is covered by group insurance, Workers' Compensation, or if other third-party liability (no-fault, liability) applies. For detailed information, refer to the CMS Guidelines and Resources for Medicare Secondary Payer (MSP).

IDENTIFYING MSP RECORDS: Check the beneficiary's eligibility file in FISS DDE (Inquiry Option 10), the CGS IVRPDF, or myCGS. If an MSP record exists and the claim date of service falls within the effective and termination dates, Medicare is secondary.

SUBMITTING MSP CLAIMS TO MEDICARE: MSP claims must be submitted electronically (ANSI ASC X12N 837 format or keyed directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE). For more information, refer to the Submitting Medicare Secondary Payer (MSP) Claims and Adjustments web page. Effective January 1, 2016, paper UB-04 claims can only be submitted if your agency meets the small provider exception (CMS Pub. 100-04, Ch. 24 §90) or if the services are related to Black Lung.

MSP BILLING RESOURCES: Specific data elements (e.g., occurrence codes, value codes, payer codes and insurer information) are required to ensure correct processing and payment. CGS offers the following resources for additional information.

SUSPENDED MSP CLAIMS: MSP claims/adjustments that require Medicare staff intervention may suspend for more than 60 days. You may call the Provider Contact Center if the claim remains in the same "S MXXXX" status/location for longer than 60 days.

MSP Resources from the Centers for Medicare & Medicaid Services (CMS)

Updated: 06.08.22


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved