Medicare Secondary Payer Changes: Paper Claims
Effective for claims processed on and after September 1, 2009, the following changes will apply to Medicare Secondary Payer (MSP) paper claims.
- The charge submitted on the CMS-1500 claim form must match the charge submitted on the Explanation of Benefits (EOB) from the primary insurer for each service. If the charges do not correspond, the services will be ‘returned as unprocessable’ (remark code MA130) and must be resubmitted as new claims. Note: Services returned as unprocessable do not have appeal rights and cannot be corrected via the telephone reopening line.
- If the submitted charges are not fully reimbursed by the primary insurer, the EOB must include a narrative description indicating the reason the charges were not fully reimbursed
- When a reason/remark code is provided by the primary insurer, the description of the reason/remark code must be indicated on the EOB
- The EOB must include the reason there was no payment or only partial payment made. This information is essential in determining the correct payment amounts. This information cannot be handwritten on the EOB. Column headings indicating co-insurance, co-pay, etc. will be considered valid descriptions.