Medicare Part B Secondary Payer

1. The electronic claim elements for NGS to process an MSP claim are as follows:

a. Indication of Medicare as the secondary payer

b. Insurance Type

c. Coordination of Benefits (COB) Payer Paid Amount – Claim Level

d. Coordination of Benefits (COB) Allowed Amount – Claim Level

e. Claim Contract Information (OTAF) – Claim Level

f. Claim Adjudication Date – Claim Level

g. Line Adjudication Information

h. Line Adjustments

i. Line Adjudication Date

• True

• False

Indication that Medicare is secondary payer is noted with:

• X

• Z

• S

The group health plan insurance type codes are 12, 13 and 43.

• True

• False

MSP is the term used when Medicare does not have primary responsibility. Other insurance pays first?

• True

• False

Providers are not responsible for determining Medicare primary versus secondary and should always just submit a claim to Medicare as primary.

• True

• False

The Medicare acronym BCRC stands for what?

• Black Coffee Resting Co

• Benefits Coordination and Recovery Center

If you want to submit an MSP (or conditional claim) for a beneficiary’s services, you must ensure that there is an open matching MSP record for the beneficiary in Medicare’s records prior to submitting the claim. If there is no matching record, you must contact the BCRC to ask them to set one up?

• True

• False

Collecting beneficiary insurance data is key to accurate claim submissions.

• True

• False

How does a provider access MSP data? Select all that apply.

• Screen patients at visits

• Check NGSConnex or IVR Eligibility

• Use the CMS MSP Model MSP Questionnaire 20.2.1

If there is an open MSP Common Working File (CWF) record that needs to be terminated or deleted. Who do you call?

• National Government Services, Inc.

• BCRC