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February 12, 2026

Reminder: Submitting Electronic Medicare Secondary Payer (MSP) Claims

When billing electronic MSP claims, please ensure the following:

  • The primary payer's payment and adjustment amounts must not exceed the billed amount for each line item; and
  • Use the correct Claim Adjustment Reason Codes and Group Codes as provided by the primary payer and confirm they align with the billed charges.

Incorrect primary insurance amounts or information can cause the claim to be out of balance, resulting in processing issues. If the primary payer's adjustments exceed the billed amount, Medicare's system cannot accurately calculate the secondary payment. This can result in:

  • Remittance discrepancies
  • Delays in claim processing

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