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Medicare Secondary Payer (MSP) Online Tool

Medicare is a secondary payer when the beneficiary is covered by group insurance, Workers' Compensation, or if other third-party liability (auto, no-fault, liability) applies. To determine if a beneficiary has an MSP record, you will need to check the beneficiary's eligibility file. Eligibility information can be accessed by using the HIPAA Eligibility Transaction System (HETS)External Website, the CGS web portal, myCGS, or the Interactive Voice Response (IVR)PDF system. MSP claims can be submitted using the ANSI ASC X12N 837 format, or via the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE). This tool is an online decision tree where you answer specific questions to determine appropriate billing of MSP claims to Medicare. CGS also offers the Medicare Secondary Payer Billing & AdjustmentsPDF quick resource tool as a resource for appropriate MSP billing. Proceed with the questions below to determine appropriate Medicare billing of your claim.

NOTE: In order for this tool to function correctly, please ensure that your pop-up blocker is enabled and javascript is turned on.

1. Does an MSP record appear on the beneficiary's eligibility file?

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