Medicare Secondary Payer (MSP) Primary Insurance Information
Medicare Secondary Payer (MSP) refers to instances in which Medicare does not have primary responsibility for paying the medical expenses of a Medicare beneficiary. This is because the Medicare beneficiary may be entitled to other coverage, which should pay primary health benefits.
In order for Palmetto GBA to appropriately determine the insurance company with primary responsibility, it is necessary to include the complete name (or properly abbreviated name) of the primary payer in the appropriate loops and segments when submitting your claims electronically.
Below are the loops and segments where this information should be located in the electronic claims format:
|
Loop, Segment, Element
|
Description
|
|---|---|
|
2330B, NM1, 103
|
Other payer last name
|
When including the primary insurance name, you should also include the complete address, when available, in order to allow for appropriate development, if applicable.
Below are the loops and segments where this information should be located in the electronic claims format:
|
Loop, Segment, Element
|
Description
|
|---|---|
|
2330B, N, 301 / 401 / 402 / 403
|
Other payer address line, city name, state/province code, ZIP Code
|
Examples of incomplete or invalid primary insurance information are as follows and if submitted as such, may result in a claim rejection:
- MVA
- MVA PB
- PPO
- Liability
- Federal
- Medical
- Hospice
- BCBS
Missing, incomplete or invalid primary insurance information will result in a rejected claim with remark code MA48.
Remark Code MA48 — "Missing/incomplete/invalid name or address of responsible party or primary payer."
You must correct and resubmit the rejected claim with valid and necessary information for proper adjudication of your claim.