Medicare Secondary Payer (MSP)

Published 10/24/2023

Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility. In this situation, another entity has the responsibility for paying on a claim before Medicare. Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. 

The CMS guidelines governing these processes can be found on the CMS website.

Other CMS Reference Material

Palmetto GBA is committed to helping providers understand the MSP process. For more information and the options available to you, please select the link below for additional information regarding the MSP process.

Topic
Brief Description
This tool is designed to help you determine if Medicare is the primary or secondary payer by walking you through a few simple questions.
The MSP Contractor consolidates the activities that support the collection, management and reporting of other insurance coverage for Medicare beneficiaries.
There are times when a provider will receive a primary payment from another insurance company after Medicare has paid as primary. When this happens, it is assumed that Medicare should be the secondary payer. If you receive two primary payments, you should refund Medicare's payment in full.
A Medicare Secondary Payer (MSP) overpayment can occur when Medicare has processed and paid a claim as the primary payer, but should have paid as secondary. 
  • In order to report an MSP overpayment to Medicare without submitting a payment, the MSP Inquiry Form must be submitted along with the primary insurer EOBs 
  • If you are submitting a payment along with the disclosed overpayment, the appropriate MSP Voluntary Refund form must be submitted along with the primary insurer EOBs

MSP records are maintained by the MSP Contractor. Medicare contractors are unable to update a patient’s insurance information with the MSP Contractor by phone. The MSP Contractor can accept MSP change information from providers in some situation. In others, the MSP Contractor may ask providers to fax or mail proof of insurance information, or require the beneficiary to call to report the change.

Providers can also reference the Medicare Learning Network (MLN) Special Edition Article SE1416 – Updating Beneficiary Information with the MSP Contractor.
 

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