- For patients that have both Medicare and Medicaid and no other insurance, Medicare is the primary payer
- In most cases, Federal law takes precedence over state laws and private contracts. Even if a state law or insurance policy states that they are a secondary payer to Medicare, the MSP regulations should be followed to determine the correct primary payer.
- Medicare records may not reflect the patient’s current insurance status. If you find that there is a discrepancy between Medicare records and the patient’s current insurance status, call the COB Contractor at (800) 999-1118.
- The COB Contractor may also need to speak to the patient; however, providers are permitted to call
- In some cases, if a patient or his/her spouse is working and is covered by an Employer Group Health Plan (EGHP), you must know the number of people employed by the company in order to use this tool most effectively. Either you or the patient may contact the employer to obtain this information.
- Providers are required to file claims on behalf of their Medicare patients, including patients for whom Medicare is the secondary payer
- These claims must be filed electronically, unless you qualify for a waiver to submit paper claims
- The only other exception to the electronic filing requirement is if Medicare is the tertiary insurer (the patient has two other insurers, both of which are primary to Medicare)
- For tips on filing MSP claims electronically, select 'Electronic Submission of MSP Claims' from the links at the bottom of the page
Still Have Questions?
| Where to Call | Issue |
Coordination of Benefits Contractor (COBC):
(800) 999-1118 |
There has been a change in the patient’s insurance status, including:
- The patient or his/her spouse recently retired
- The patient was recently in an auto or other type of accident
- The patient’s Medicare records need to be corrected because:
- Medicare should be secondary for the patient, but Medicare has been making primary payments
- Medicare should be primary for the patient, but the patient’s claims are all being denied because Medicare is secondary
|
Palmetto GBA:
Provider Contact Center
(866) 332-7025 |
You have a question about how a specific claim was processed.
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Other MSP Resources
Palmetto GBA Web site:
- Check out the MSP FAQs. Select FAQs and then MSP.
- For information on how to submit claims when you are contractually obligated to accept a set fee from another primary insurer: Refer to the article titled 'Obligated To Accept as Payment in Full'