Medicare Secondary Payer (MSP)

Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility. In this situation, another entity has the responsibility for paying on a claim before Medicare. Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. 

The CMS guidelines governing these processes can be found on the CMS website under:

Other CMS reference material:

Palmetto GBA is committed to helping providers understand the MSP process. For more information and the options available to you, please select the link below for additional information regarding the MSP process.

Topic
Brief Description
This tool is designed to help you determine if Medicare is the primary or secondary payer by walking you through a few simple questions.
The BCRC consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries.
The information on this tip sheet is designed to assist providers in understanding when Medicare will make a conditional payment for Medicare covered services.
There are times when a provider will receive a primary payment from another insurance company after Medicare has paid as primary. When this happens, it is assumed that Medicare should be the secondary payer. If you receive two primary payments, you should refund Medicare's payment in full.
A Medicare Secondary Payer (MSP) overpayment can occur when Medicare has processed and paid a claim as the primary payer, but should have paid as secondary. 
  • In order to report an MSP overpayment to Medicare without submitting a payment, the MSP Inquiry Form must be submitted along with the primary insurer EOBs. 
  • If you are submitting a payment along with the disclosed overpayment, the appropriate MSP Voluntary Refund form must be submitted along with the primary insurer EOBs. 
Information about the primary insurer and primary payment are required for all MSP claims. The OTAF amount is equal to the amount of the primary payer's payment plus any patient responsibility
MSP records are maintained by the BCRC.  Medicare contractors are unable to update a patient’s insurance information with the BCRC by phone. The BCRC can accept MSP change information from providers in some situation. In others, the BCRC may ask providers to fax or mail proof of insurance information, or require the beneficiary to call to report the change. 
 
Providers can also reference the Medicare Learning Network (MLN) Special Edition Article SE1416 – Updating Beneficiary Information with the Benefits Coordination & Recovery Center.
The top five errors identified during a MSP hospital audit


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