Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents

• Prevent an MSP Rejection on a Medicare Primary Claim
• Step 1
• Step 2
• Step 3
• Related Content

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Prevent an MSP Rejection on a Medicare Primary Claim

If you submit a Medicare primary claim when there is other insurance primary for the beneficiary, you are likely to receive a claim rejection for MSP.

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Step 1

You will need the beneficiary’s identifying information. Model Admission Questions to Ask Medicare Beneficiaries.

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Step 2

Take note that any claims for nongroup health plans, such as workers’ compensation, automobile, and no-fault shall be submitted to the appropriate insurer responsible for the inquiries. See CMS’ Non-Group Health Plan Recovery web page.

Be aware, beneficiaries may be working and have a group health plan that’s primary to Medicare. See CMS’ Group Health Plan Recovery web page.

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Step 3

Once you have the correct beneficiary MSP data, submit the Medicare claim as appropriate.

If your claim denies for MSP, you may submit a clerical error reopening to resolve it. Refer to Correct or Reopen a Claim due to a MSP-related Issue.

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Related Content

• CMS IOM Publication 100-05, Medicare Secondary Payer Manual,
  • Chapter 3, MSP Provider, Physician, and Other Supplier Billing Requirements, Sections 20.1 and 20.2
  • Chapter 5, Contractor Prepayment Processing Requirement, Sections 70.3B and 70.3.1.1A & B
• CMS Benefits Coordination & Recovery Center web page

Revised 10/25/2023