The Administrative Simplification Compliance Act (ASCA) requires that claims be submitted to Medicare electronically with few exceptions. MSP claims are not an exception unless there is more than one primary payer to Medicare.

Complete information about submitting electronic MSP claims is included in the "837 version of the 5010A1 Professional Implementation Guide." Follow the instructions in the following table for submitting MSP information electronically.

 
Line Level Services
Claim Level Information
Primary Payer Paid Amount
Loop ID 2430 SVD02
Loop ID 2320 AMT02
AMT01=D
Remaining Patient Liability
Loop ID 2430/AMT/EAF
Loop ID 2320/AMT/EAF

It is important that the primary payer paid amount and the remaining patient liability be entered so that the correct secondary payment is made. If the amounts are entered incorrectly, this could cause overpayments to be made. If it comes to the attention of Medicare that information was entered inaccurately and an overpayment has occurred, Medicare will request a refund of the overpayment amount.

Note

  • The primary payer's paid amount is always required at the claim level when billing MSP. The primary payer's paid amount must also be given at the line level. 
  • When billing more than one service on the claim, the line level calculations must always be utilized
  • When providing claim level and line level information, be sure the amounts balance at the line level to what the claim level equals. If the amounts are not the same, this could cause a delay in the processing of the claim. 
  • If the 2430 Loop is being used, both the SVD and the DTP/573 segments must be included
  • The Remaining Patient Liability (2430/AMT/EAF) must not be repeated at the line level Remaining Patient Liability (2430/AMT/EAF). If you choose to provide this data element at the line level, then you must not provide it at the claim level.

Reference: The Implementation Guide is available on the ASC X12 website.

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