Corporate

January 13, 2016

Changes in Submitting Medicare Secondary Payer (MSP) Claims and Adjustments

Change Request (CR) 8486 implemented changes that allow providers to submit Medicare Secondary Payer (MSP) claims and adjustments (with the exception of Black Lung claims) via the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE). This change is effective for claims received on or after January 1, 2016.

Prior to this change, providers were unable to submit claims via DDE as it did not accept claim adjustment segment (CAS) information; therefore, it was necessary for providers to submit claims and adjustments electronically using the 5010 format.

NOTE: With the implementation of this CR, CGS will no longer accept MSP paper claim submissions, except for Black Lung claims or if you meet the small provider exception (CMS Pub. 100-04, Ch. 24External PDF §90).

New FISS DDE MSP Payment Information Screen

For claims received on or after January 1, 2016, providers can now enter MSP claims directly into FISS via DDE. MSP information is entered on the new "MSP Payment Information" screen (MAP1719), which can be accessed from Claim Page 03 (MAP1713) by pressing F11. If there are two primary payers, press F6 to display a second "MSP Payment Information" screen for primary payer 2.

The 835 remittance advice providers receive from the primary payer includes claim adjustment and payment information associated with the primary payer's claim determination. This information is entered on the "MSP Payment Information" screen, which accommodates up to 20 entries for primary payer 1, and 20 entries for primary payer 2 (if there is one). Refer to the following field name and description for additional information.

Field Name Description
PAID DATE Enter the paid date shown on the primary payer's remittance advice.
PAID AMOUNT Enter the paid amount shown on the primary payer's remittance advice. This amount must equal the dollar amount entered for MSP Value Code 12, 13, 14, 15, 41, 43 or 47.
GRP Enter the Group Code shown on the primary payer's remittance advice.
CARC Enter the Claim Adjustment Reason Code (CARC) shown on the primary payer's remittance advice.
AMT Enter the dollar amount associated with the group code and CARC.

screenshot

Press F6 to access the "MSP Payment Information" screen for primary payer 2 (if there is one). Press F5 to move back to the primary payer 1 "MSP Payment Information" screen.

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Correcting MSP Claims and Adjustments

Providers are now able to correct MSP claims out of the Return to Provider (RTP) file; however, providers must ensure that MSP information is entered on the "MSP Payment Information" screen. For claims submitted electronically via the 5010 format, on or after January 1, 2016, the CAS segment information will map to the appropriate fields on the "MSP Payment Information" screen.

Providers may submit adjustments to MSP claims via 5010 or FISS DDE. However, if using FISS DDE, as with claims in RTP, providers must ensure the MSP information is entered on the "MSP Payment Information" screen.

Please note that CGS will be working to update the MSP educational materials on our website, and will notify you when updating is completed. For additional information, please refer to the Change Request 8486External PDF or the associated MM8486External PDF article.


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