where does the medicare msp go on hcfa

How do I submit an MSP claim to Medicare?

SUBMITTING MSP CLAIMS TO MEDICARE: Claims that include MSP information must be submitted either electronically (ANSI ASC X12N 837 format) or by entering the MSP claim directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE).

Where can I find more information on CMS's Medicare secondary payer guidelines?

For detailed information on CMS's Medicare Secondary Payer guidelines, refer to the CGS web page, ' CMS Guidelines and Resources for Medicare Secondary Payer (MSP) ', for links to the various CMS MSP regulations.

What is Medicare Part MSP and how does it protect Medicare?

The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage.

Who can fill out the HCFA form?

Below are some of the people who can fill the form; Only non-institutional healthcare providers should submit insurance claims using the HCFA form. Institutional providers should submit applications using the UB-04 form. For the insurance claims to be met, some set industry standard and protocols have to be met.

Does MSP mean Medicare is secondary?

Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.

What is Medicare MSP code?

Medicare Secondary Payer (MSP) Value Codes The 14-value code should only be used for an individual entitled to Medicare and was in an accident or other situation where no-fault or liability insurance is involved.

Where do you put none with Medicare as a primary payer claim?

If there is no insurance primary to Medicare, the word "none" should be entered in block 11. Completion of item 11 (i.e., insured's policy/group number or "none") is required on all claims.

Is MSP form required for Medicare Advantage plans?

Based on this regulation, hospitals must document and maintain MSP information for Medicare beneficiaries. Without this documentation, the contractor would have nothing to audit submitted claims against. CMS recommends that providers retain MSP information for 10 years.

How do you use MSP codes?

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How do you find MSP?

The MSP Questionnaire Form can be found at: www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Downloads/CMS-Questionnaire.pdf. Please remember that there may be situations where more than one payer is primary to Medicare (e.g., liability insurer and group health plan [GHP]).

What goes in box 33 on a HCFA?

Box 33 is used to indicate the name and address of the Billing Provider that is requesting to be paid for the services rendered. Enter the name, address, city, state, and ZIP code. P.O. Boxes are not allowed for electronic claims.

What goes in box 17a on CMS 1500?

Item 17a – Enter the ID qualifier 1G, followed by the CMS assigned UPIN of the referring/ordering physician listed in item 17. The UPIN may be reported on the Form CMS-1500 until May 22, 2007, and MUST be reported if an NPI is not available.

How do I fill out a Medicare HCFA 1500 form?

14:5319:58How-to Accurately Fill Out the CMS 1500 Form for Faster PaymentYouTubeStart of suggested clipEnd of suggested clipField 1 is the very first field on the CMS 1500 form and it tells the insurance carrier the categoryMoreField 1 is the very first field on the CMS 1500 form and it tells the insurance carrier the category of insurance that the policy falls into. It can be left blank.

What is MSP insurance type code?

The MSP insurance type identifies the type of other insurance specific to the MSP provision that is the basis for the beneficiary's MSP status. For claims billed electronically, the code is submitted in loop 2000B, within the SBR 05 segment of the ANSI X12 5010 format.

Is the MSP questionnaire required?

You are not required to collect MSP information (complete a new questionnaire) from beneficiaries if you have the ability to access MSP information in CWF or send/receive a X12 270/271 transaction.

What is my MSP account number?

Your MSP account number is listed on the top of your invoice (e.g. X36012345678).

What is CWF code?

When a contractor receives claims with more than one insurance type code, the contractor must send the shared system and CWF the insurance type code associated with the highest other payer total claim payment amount. For example, a Medicare beneficiary sustains injury in a car accident. Five services were performed on the beneficiary. Since the services performed were related to the accident, the no-fault insurer (referred to as insurance type code 14) makes a $500.00 payment on each line of the claim totaling $2,500.00. The beneficiary also has coverage through the spouse’s group health plan. The spouse’s plan (referred to as insurance type code 12) makes a $400.00 payment on each line of the claim totaling $2000.00. The contractor must send insurance type code 14 (not insurance type code 12) to the shared system and CWF.

How often do you need to collect MSP information?

Following the initial collection, the MSP information should be verified once every 90 days. If the MSP information collected by the hospital, from the beneficiary or his/her representative and used for billing, is no older than 90 calendar days from the date the service was rendered, then that information may be used to bill Medicare for recurring outpatient services furnished by hospitals. This policy, however, will not be a valid defense to Medicare’s right to recover when a mistaken payment situation is later found to exist.

What is the OTAF number for loop 2400?

For line level services, physicians and other suppliers must indicate the OTAF amount for that service line in loop 2400 CN102 CN 101 = 09. The OTAF amount must be greater than zero if there is an OTAF amount, or if OTAF applies.

When a provider receives a reduced no fault payment because of failure to file a proper claim, what is

When a provider receives a reduced no-fault payment because of failure to file a proper claim, (see Chapter 1, §20 for definition), the Medicare secondary payment may not exceed the amount that would have been payable if the no-fault insurer had paid on the basis of a proper claim.

Can you send a claim to Medicare with multiple primary payers?

Claims with multiple primary payers cannot be sent electronically to Medicare.

Is GHP primary to Medicare?

Do you have employer group health plan (GHP) coverage through yourself, a spouse, or family member if dually entitled based on Disability and ESRD? If yes, the employer GHP may be primary to Medicare. Continue below.

Can a beneficiary recall his/her retirement date?

During the intake process, when a beneficiary cannot recall his/her precise retirement date as it relates to coverage under a group health plan as a policyholder or cannot recall the same information as it relates to his/her spouse, as applicable, hospitals must follow the policy below.

Submitting MSP Claims via FISS DDE or 5010

All MSP claims submitted via FISS DDE or 5010 must report claim adjustment segment (CAS) information. In FISS DDE, the CAS information is entered on the "MSP Payment Information" screen (MAP1719), which is accessed from Claim Page 03 by pressing F11. This is in addition to the normal MSP coding information.

Correcting MSP Claims and Adjustments

Return to Provider (RTP): MSP claims may be corrected out of the RTP file (status/location T B9997). However, providers must ensure that claim adjustment segment (CAS) information is reported on the "MSP Payment Information" screen (MAP1719), accessed from Claim Page 03 by pressing F11.

What is a secondary payer for Medicare?

When submitting an electronic claim to Medicare, you are required to obtain Medicare Secondary Payer (MSP) insurance information from the patient. The patient’s insurance is classified as either a group health plan (GHP) or a non-group health plan (NGHP). Examples of GHP coverage are Working Aged (WA), Disability, or End Stage Renal Disease (ESRD); based on current or past employment. Examples of NGHP coverage are Automobile/no-fault, Workers’ Compensation (WC), and Liability; typically the result of an accident, injury, or lawsuit. Although there are other types of MSP coverage, these are the most common.

How old do you have to be to get disability insurance?

The beneficiary must be aged 65 or older. There must be at least 20 or more employees. Disability – This coverage is for beneficiaries who are under age 65 and disabled. Insurance is based on their own current employment or through the current employment of a family member. There must be 100 or more employees.

What is self insured liability?

Liability – Insurance (including a self-insured plan) that provides payment based on the policyholder’s alleged legal liability for injury, illness or damage to property. Some examples of this coverage could be product liability, malpractice, and homeowner’s coverage. Please take a few minutes to obtain MSP insurance information and report ...

What are some examples of GHP?

Examples of GHP coverage are Working Aged (WA), Disability, or End Stage Renal Disease (ESRD); based on current or past employment. Examples of NGHP coverage are Automobile/no-fault, Workers’ Compensation (WC), and Liability; typically the result of an accident, injury, or lawsuit.

Is Medicare a secondary payer?

Medicare is secondary payer for the first 30 months. There is no age restriction on this type of coverage. The beneficiary may be under or over age 65. Automobile/no-fault – No-Fault insurance that pays for medical expenses for injuries sustained from a motor vehicle accident.

What are the items that Medicare may be secondary to?

If there is insurance primary to Medicare, enter the insured’s policy or group number and then proceed to Items 11a–11c. Items 4, 6, and 7 must also be completed. Circumstances under which Medicare may be secondary to another insurer, includes: Group health plan coverage. Working aged;

What is EOB in Medicare?

If the primary payer’s explanation of benefits (EOB) does not contain the claims processing address, record the claims processing address directly on the EOB. Completion of this item is conditional for insurance information primary to Medicare.

What to do if there is no Medicare primary?

If there is no insurance primary to Medicare, enter the word “none”. If there has been a change in the insured’s insurance status, e.g., retired, enter the word “none” and proceed to item 11b. Item 11a-Insured's date of birth: Enter the insured’s eight-digit birth date (MM/DD/CCYY) and sex if different from Item 3.

What does "yes" mean on Medicare?

Any item checked "yes" indicates there may be other insurance primary to Medicare. Identify primary insurance information in item 11. Completion of items 10a-c is required for all claims; "yes" or "no" must be indicated.

What is the word "none" in Medicare?

If there is no insurance primary to Medicare, the word "none" should be entered in block 11. Completion of item 11 (i.e., insured's policy/group number or " none ") is required on all claims. Claims without this information will be rejected.

When submitting paper or electronic claims, what is item 11?

When submitting paper or electronic claims, item 11 must be completed. By completing this information, the physician / supplier acknowledges having made a good faith effort to determine whether Medicare is the primary or secondary payer. Claims without this information will be rejected.

Is Medicare required to pay item 29?

Not required by Medicare. Item 29-Amount paid: Enter only the amount the patient paid on Medicare covered services. Note: Providers should never enter the amount the primary insurance paid in Item 29 or the electronic equivalent.

What is HCFA billing?

Here’s what to know about this form. The Health Care Finance Administration ( HCFA) form is a claim form used in settlement of government insurance programs such as Medicare and Medicaid to medical providers.

What is the final section of a biller's NPI?

This is the final section and identifies that the provider is requesting payment for the rendered services.

What is HCFA/CMS-1500?

The HCFA/CMS-1500. This form is universal, and all healthcare providers use them to bill health insurance providers. Both Medicaid and Medicare, part B services, are billed using this form. The National Uniform Claim Committee (NUCC) maintains this form. The HCFA contains all the essential info required to submit a precise claim.

What information is included in HCFA?

In this form, the healthcare provider should include the following; Patient’s demographic information. Patient’s insurance information. Medical Codes. Dates of service. The information filed in this form should be accurate and factual.

Why should healthcare providers be truthful when filling out a claim?

To avoid disputes, healthcare providers should be truthful when filling the form. In case the insurance detects irregularities, they may fail to honor the claims. There is a specific box that applies to each health provider. The payer might provide different info on how to fill some boxes.

What is Mike Cynar?

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How many digits should a patient sign?

Patient’s Signature. The patient should sign on the file. If the patient is debilitated, then an authorized representative should sign or enter a 6-digit/8-digit alphanumeric date. If a representative signs, the reasons should be indicated on the line followed by the representative’s relationship and personal details.

Submitting MSP Claims Via Fiss DDE Or 5010

See more on cgsmedicare.com

Additional Information

Correcting MSP Claims and Adjustments

References