MSP Electronic Billing Instructions (MSP Medicare Secondary Payer)

The Centers for Medicare and Medicaid Services (CMS) now requires all claims, including MSP claims, to be filed electronically, with few exceptions. Please reference CMS Change Request 3440 Globe to indicate www link.and the Administration Simplification Compliance Act (ASCA) of 2001. An exception to this rule is when there is more than one payer responsible for payment before Medicare considers the charges. These claims may still be submitted hardcopy. Complete information about submitting electronic MSP claims is included in the “4010A1 Professional Implementation Guide 837”.

If another insurance company pays primary benefits, secondary Medicare benefits may be payable to supplement the amount paid by the primary insurer. Medicare secondary benefits may be payable if all of the following situations apply:

    * The primary insurer’s payment is less than the provider’s charges for Medicare covered services;
    * The primary insurer’s payment is less than the maximum amount payable by Medicare; and,
    * The provider does not accept and is not obligated to accept the primary insurer’s primary payment as payment in full.