Valid MSP Types for Electronic Claims

Published 01/04/2021

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.

Valid MSP types that may be submitted on an electronic claim:

MSP Type
Description
12
Working aged: age 65 or over, employer's group plan has at least 20 employees
13
End-Stage Renal Disease (ESRD): 30-month initial coordination period in which other insurer is primary
14
No-fault situations: Medicare is secondary if illness/injury results from a no-fault liability.
15
Workers' compensation (WC) situations
41
Black Lung benefits
43
Disability: under age 65, person or spouse has active employment status and employer's group plan has at least 100 employees
47
Liability situations: Medicare is secondary if illness/injury results from a liability situation
  • Submit the MSP type in loop 2000B, SBR, 05 (insurance type Code) field
  • Always submit the type appropriate for the beneficiary's insurance coverage
  • If a MSP type is submitted that does not correspond to the information Medicare has on file, your claim will be rejected. Rejected claims must be submitted as a new claim.

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