Narrative: This care may be covered by another payer per coordination of benefits.
Narrative: Health care policy coverage is primary.
Reason for Non-Coverage
When Medicare is the secondary payer, the payer primary to Medicare must be billed first
Yes, it applies for the denied claims; it does not apply to rejected claims.
Reference and Educational Material
- CMS IOM Publication 100-05, Chapter 1 (PDF, 188 KB), Section 120
- Palmetto GBA MSP: Eligibility and Denials Reference article (JJB, JMB)
To find out whether Medicare should pay as primary or secondary, use the Palmetto GBA MSP Lookup Tool located on the home page under Tools. Ask your patient a series of yes or no questions and select the answers using our online tool.
If Medicare records do not match the MSP Lookup Tool outcome, refer the patient to the Coordination of Benefits Contractor to have his or her records corrected.
What to Include in the Appeal?
Most MSP denials are corrected with a reopening due to billing error or change/update to information. However, when requesting a redetermination, provide all documentation that supports the service as not related to the diagnosis or injuries covered by another coordination of benefits payer.