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March 5, 2014 - Revised: 08.07.20

Medicare Secondary Payer Information and Filing Claims: Getting It Right the First Time

Based on analysis of claim denials, submission errors (claims that are "rejected as unprocessable"), reopening requests, and calls made to our office, we know that Medicare Secondary Payer (MSP) claims are one of the top areas of concern for health care providers and their staff members. This article provides tips for ensuring that the MSP information on your claims is as accurate as possible.

Step 1: Verify your patients' insurance information at each encounter.

  • Obtain paper or electronic copies of insurance cards.
  • Be aware that even patients that have elected coverage through a Medicare Advantage (MA) plan may still keep their original red, white and blue Medicare cards.
  • Patients may elect new plans each year. In some situations, coverage may change in the middle of the calendar year.
  • Ask questions about coverage through other insurers. Your office or practice may have a standard questionnaire to gather this information; you may also use the CMS MSP questionnaire (in the CMS Medicare Secondary Payer Manual (Pub. 100-05), chapter 3, section 20.2.1External PDF). Note: There is NO requirement for Part B providers to use this survey.
    • This information may change periodically, based on changes in the patient's employment or that of his/her spouse or other factors. In addition, if the beneficiary is being seen for a potential trauma diagnosis, this could indicate that the patient may potentially be covered by liability insurance.

Step 2: Verify the information in Medicare's records.

Step 3:

  • File with the correct insurer first. When a patient is covered through Medicare and another insurer, the determination of whether Medicare pays first or second is based on law.
  • When Medicare is secondary, submit information about the primary insurer and any payment received from that insurer with your Medicare claim.
    • Special note: filing an MSP claim with Medicare that contains outdated MSP information (such as a primary payer that no longer covers that patient) triggers the Benefits Coordination and Recovery Contractor (BCRC) to open an investigation on the patient's insurance status. This can significantly delay processing time and/or change the patient's secondary status. Double-check the accuracy of the MSP information before you submit a claim to Medicare.
  • You may file MSP claims electronically through your commercially available billing platforms. Do not "drop to paper." For more information on the correct fields, loops, and segments, refer to the CGS CMS-1500 Claim Form/ANSI CrosswalkPDF. Also, coordinate with your clearinghouse to verify that the information that is being sent is current.
  • If your software will not allow you to submit MSP claims electronically, or if you are currently a paper submitter, please use myCGS. Not only can you submit regular claims, but you can also submit MSP claims. All for FREE! Refer to the MSP section of the myCGS User Manual for step-by-step instructions.

Reference:

Reviewed: 12.07.22

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