Correct a Beneficiary's MSP Record
Table of Contents
- Background
- Step 1: Provider Receives Information Indicating Medicare Is the Primary Payer for a Beneficiary's Services
- Step 2: Prepare and Submit a Medicare Primary Claim With the Reason Medicare Is the Primary Payer
- Step 3: Check the Status of Your Medicare Primary Claim
- Step 4: Check the Common Working File For Each Medicare Primary Claim We Return to You
- Step 5: Return Your Medicare Primary Claim To Us Once the Medicare Secondary Payer Record is Corrected
- Related Content
Background
The Benefits Coordination & Recovery Center is responsible for maintaining all MSP records in the CWF. Providers should not contact the BCRC to correct MSP records. If you receive information that can correct a beneficiary’s MSP record making Medicare the primary payer for the services, report claim coding on your Medicare primary claim to notify us. We will ask the BCRC to correct the MSP record, if necessary, using the information from your claim. If there is no applicable claim coding to notify us of the reason we are the primary payer for the services, you can ask the beneficiary or other party to contact the BCRC to request a correction to the MSP record.
Step 1: Provider Receives Information Indicating Medicare Is the Primary Payer for a Beneficiary’s Services
Providers must conduct an MSP screening process with each beneficiary to identify payers that may be primary to Medicare. You must check if the beneficiary has an MSP record in the CWF and you may need to ask them questions about their current MSP status. Refer to Identify the Proper Order of Payers for a Beneficiary’s Services.
During the MSP screening process, you may find an MSP record for the beneficiary indicating another payer is primary to Medicare. You may also receive information from the beneficiary leading you to determine Medicare is the primary payer for their services. Document the information you receive explaining the reason Medicare is the primary payer so you can report it to us on your Medicare primary claim. You should do this even if the beneficiary does not have an MSP record in the CWF.
To process a Medicare primary claim for a beneficiary who has an open MSP record in the CWF, we must send the information from your claim to the BCRC that indicates the reason we are the primary payer and we must ask them to correct the MSP record. This is true in all cases except one, discussed below in step 2.
Step 2: Prepare and Submit a Medicare Primary Claim with the Reason Medicare Is the Primary Payer
There are many reasons you may have determined Medicare is the primary payer for a beneficiary’s services even though the beneficiary has an MSP record in the CWF.
To prevent your Medicare primary claim from rejecting for MSP and to allow us to process it for primary payment, report applicable coding on the claim, if available, indicating the reason Medicare is the primary payer. To determine the coding you can report on your claim, review Prevent a MSP Rejection on a Medicare Primary Claim.
This claim coding includes:
- CCs 09, 10, 11, 28 and 29 as well as OCs 18, 19 and 25. Note: When reporting any of these CCs and/or OCs, you can also report remarks to provide more details.
- Remarks to indicate the services are not related to an accident MSP record (VC 14, 15 or 47).
Once you prepare your Medicare primary claim with the available claim coding, submit it to us.
However, if there is no applicable coding to report on your claim to indicate the reason Medicare is the primary payer, do not contact the BCRC and do not submit the claim. You can ask the beneficiary or other party to contact the BCRC to request a correction to the MSP record. In this case, keep checking the CWF for the MSP record to be corrected using the provider self-service tools listed under Step 2 of Identify the Proper Order of Payers for a Beneficiary’s Services. Once the MSP record is correct, prepare and submit your Medicare primary claim.
Processing Medicare Primary Claims and Correcting MSP Records
When processing your Medicare primary claims, we check to determine if there is an MSP record for the beneficiary in the CWF. We can pay your claim if it contains remarks indicating the services are not related to an accident (VC 14, 15 or 47) MSP record. If your claim contains other reasons Medicare is the primary payer and the beneficiary’s MSP record requires a correction, we need to send the information from your claim to the BCRC and ask them to correct the MSP record. To do so, we use an Electronic Correspondence Referral System request. While we wait for the BCRC, we RTP your claim. It can take up to 45 days for the BCRC to correct the MSP record. The BCRC does not correct the MSP record if they do not receive a response to their investigation within 45 days or if they received a response to their investigation but determined Medicare is not the primary payer.
Step 3: Check the Status of Your Medicare Primary Claim
You can check the status of your Medicare primary claim in FISS DDE and review its assigned status location (S/L). Paid claims are in S/L PB9997 and RTP claims are in S/L TB9997.
Your claim may be paid (S/L PB9997) if:
- You reported on your claim the services are not related to an accident MSP record and, as a result, we did not need to contact the BCRC.
- You reported on your claim any other reason we are the primary payer and the beneficiary did not have an MSP record in the CWF.
If your claim is paid, do not move to steps 4 and 5. No further action is required.
Your claim may be RTP (S/L TB9997) if:
- You reported on your clam any other reason we are the primary payer for the services, the beneficiary had an MSP record in the CWF that needed to be corrected, we contacted the BCRC to ask them to correct the MSP record and we are waiting for them to correct the MSP record so we can pay the claim.
Step 4: Check the CWF for Each Medicare Primary Claim We Returned to You
For each claim we RTP while we are waiting for the BCRC to correct the beneficiary’s MSP record, continue to check the CWF to determine when the MSP record has been corrected. Use the provider self-service tools listed under Step 2 of Identify the Proper Order of Payers for a Beneficiary’s Services. If the BCRC corrected the MSP record, move to step 5.
Note: If the BCRC did not correct the MSP record and 45 days have passed since the date we RTP your claim, refer the beneficiary or other party to the BCRC to correct the MSP record or to determine the reason the BCRC did not correct the MSP record when we requested it. If the result is that Medicare is the primary payer, return the claim to us once the BCRC updates the MSP record. If the result is that another payer is primary, submit a claim to that payer. Once you are paid, change the claim we RTP to an MSP claim and return it to us.
Step 5: Return Your Medicare Primary Claim To Us Once the MSP Record is Corrected
Return each Medicare primary claim to us that we had RTP once you determine the BCRC corrected the beneficiary’s MSP record in the CWF. To do so, hit the PF9 key. Remember that when a claim is RTP, it is not considered submitted to us and may fail timely filing if not returned to us promptly.
Related Content
- CMS IOM Publication 100-05, Medicare Secondary Payer Manual, Chapter 5
- CMS IOM Publication 100-05, Medicare Secondary Payer Manual, Chapter 6
- Coordination of Benefits & Recovery Contact Page (for BCRC)
- MLN® Booklet: Medicare Secondary Payer
- Identify the Proper Order of Payers for a Beneficiary’s Services
- Prevent an MSP Rejection on a Medicare Primary Claim
Revised 12/10/2024