Medicare Secondary Payer

Published 07/15/2022

No. The GHP may request that the provider either submit an initial claim to Medicare or request that Medicare reopen its determination on previously submitted claims for the services; however, normal Medicare timely filing and reopening rules apply to these situations. Please refer to Section 10.5 — Incorrect GHP Primary Payments (PDF).

Last Reviewed: 07/15/2022

HIPAA Electronic Data Interchange (EDI) Front End Updates made it possible to submit Medicare Secondary Payer (MSP) and Tertiary Payer claims as of January 1, 2017. You may refer to Change Request 9666 (PDF) for details. You may also utilize Direct Data Entry (DDE) to submit MSP and Tertiary Payer claims.

Last Reviewed: 07/15/2022

In order for a claim to be processed as Medicare primary or secondary, the claim must coincide with the information on the common working file (CWF). When a claim is rejected due to conflicting information on CWF, providers should wait until the CWF is updated before submitting any additional claims for that beneficiary. Palmetto GBA is holding claims for up to 75 days for the CWF to be updated.

Claims will be returned to the provider requesting CWF review prior to resubmission. Once the record on CWF is updated, the provider should submit the claim at that time.

Last Reviewed: 07/15/2022