by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 17th, 2014
MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage. Before you submit a claim, you must determine whether Medicare is the primary or secondary payer for all inpatient admissions and outpatient encounters, thereby assisting in ensuring the appropriate use of Medicare funds. If another plan, insurer, or program is the primary payer, you must identify such payers on the claim you submit to Medicare.
A primary payer has the first responsibility to process the claim. You can determine who the primary payer is by asking the beneficiary about their other health insurance or coverage or referring to the Common Working File (CWF). However, you should not rely on CWF information alone since MSP health care insurance coverage can change quickly.
The following secondary payer information can be found via the MSP Auxiliary File in the CWF:
- MSP effective date
- MSP termination date
- Patient relationship
- Subscriber name
- Subscriber policy number
- Insurer type
- Insurer information (name, group number, address, city, State, and ZIP code)
- MSP type
- Remarks code
- Employer information (name, address, city, State, and ZIP code)
- Employee information (identification number)