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Medicare Secondary Payer (MSP) Line Level Calculator

Calculate the line-by-line claim payment for covered services when Medicare is the secondary payer (MSP) by following the instructions below.

Instructions:

  1. Enter the appropriate values in each of the green fields. The blue fields will calculate automatically.
  2. In the Obligated to Accept (OTA) field, enter "Y" (for "yes") if the supplier is obligated to accept the primary insurer's allowed amount as payment in full. Otherwise, enter N (for "no"), or leave the field as is. For an explanation of OTA, see Chapter 11 of the Supplier ManualPDF.
  3. NOTE: If the primary paid amount is zero, then the supplier is not obligated to accept; the calculator does take this into account. You must enter $0.00 in the Primary Payment Amount.
  4. Once you have entered all of the appropriate values, press ENTER.

Note: If the amount in the Medicare Secondary Payment is negative, please review the primary EOB to verify amounts are correct.

Medicare Allowed Amount Medicare Deductible Applied Primary Allowed Amount OTA? Primary Payment Amount Medicare Secondary Payment
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Total

Explanation of Obligated to Accept (OTA)

Obligated to Accept (OTA) is a term used when a supplier has a contractual agreement to accept the primary insurance's allowed amount as payment in full (similar to accepting assignment). See the MSP page for more information. 

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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