Effective October 5, 2009, Medicare Secondary Payer (MSP) claims and MSP Adjustments Can No Longer Be Entered Directly Into the Fiscal Intermediary Standard System (FISS) Via Direct Data Entry (DDE)
Change Request (CR) 6426, issued June 26, 2009, by the Centers for Medicare & Medicaid Services (CMS) states that effective October 5, 2009, Medicare Secondary Payer (MSP) claims and MSP adjustments can no longer be entered directly into the Fiscal Intermediary Standard System (FISS) via direct data entry (DDE). MSP claims and adjustments sent prior to October 5, 2009, will remain suspended in status/location MMSP3 until the implementation of a system update.
Providers have the following options to submit MSP claims to Palmetto GBA:
Providers Who Submit Claims and Adjustments Via DDE
DDE submitters may submit MSP claims electronically using the PC-ACE Pro32 Software. PC-ACE Pro32 is free software that can be downloaded from the Palmetto GBA Web site. PC-ACE Pro32 is a Windows-based claims processing system for electronic health care claims submission in the HIPAA-compliant format. For information on ordering the PC-ACE Pro32 Software, please visit the Palmetto GBA Web site at www.PalmettoGBA.com/anc (for North Carolina Part A providers), www.PalmettoGBA.com/asc (for South Carolina Part A providers) and www.PalmettoGBA.com/rhhi (for home health hospice providers) under the EDI section of Software and Manuals.
Effective October 5, 2009, MSP information entered via FISS DDE on a Medicare claim or adjustment will return to the provider (RTP). Pressing the F1 key from any claim page will give providers an explanation of the reason code applied to the claim.
Providers Who Submit Claims Via Vendor Software Programs
To ensure that MSP claims are calculated properly, providers must submit CAS segments on MSP claims and adjustments. CAS segment related group codes, claim adjustment reason codes and associated adjustment amounts must be included on the American National Standard Institute (ANSI) ASC X12N 837 4010-A1 MSP claim you send to Medicare. CAS segments are not utilized in the DDE environment. As a result, the provider must take the CAS segment adjustments, as found on the 835, and report these adjustments on the 837 unchanged when sending the claim to Medicare for secondary payment.
Providers who are unable to submit MSP claims and adjustments via the 837, should contact their software vendor for additional information regarding submitting MSP claims and adjustments via the 837.
Providers Who Submit Claims and Adjustments on a Hardcopy CMS-1450 (UB-04) Claim Form
Providers may submit MSP claims and adjustments on a hardcopy/paper CMS-1450 (UB-04) claim form. However, because of the Medicare requirement for mandatory electronic submission of Medicare claims, (CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 24, Section 90), which is available on the CMS Web site (PDF, 681 KB), providers may not submit paper or original claims unless they meet the small provider exception or they meet one the other exceptions outlined in the Medicare Claims Processing Manual. For qualified hardcopy submitters, MSP claims and adjustments may be submitted on a hardcopy/paper CMS-1450 (UB-04) and mailed to:
Palmetto GBA
Claims Department
Mail Code: AG-600
P.O. Box 100238
Columbia, SC 29202-3238