Medicare Secondary Payer (MSP)

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  • MSP states that Medicare will be the secondary payer and other insurance will pay as the primary first.
  • Once the claim is paid by primary insurance then Medicare should be billed with primary EOB along with the correct MSP code.
  • Whenever Medicare insurance is billed as secondary insurance, it is necessary to update the MSP code, or else Medicare will deny the claim for primary EOB.
  • You can find the MSP code on the Medicare website where primary insurance information will be available along with the MSP code under the MSP tab.
  • If you do not have access to the Medicare website then the same information can be obtained through Medicare IVR by checking eligibility.
  • MSP Code or Type:

       12 – Working Aged Beneficiary or Spouse with Employer Group Health Plan
       13 – End-Stage Renal Disease Beneficiary in the 30-Month Coordination Period with an Employer’s Group Health Plan
       14 – No-fault insurance, including auto, is primary (any no-fault insurance)
       15 – Workers’ Compensation
       41 – Black Lung
       43 – Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
       47 – Other Liability Insurance is primary 

  • Do not bill Medicare as a secondary payer when the website shows Medicare is primary, Medicare will keep denying the claim for the same reason. In this case, update Medicare as primary and resubmit the claim. 
  • If the claim is already paid by primary insurance and the Medicare website shows Medicare itself as primary insurance then bill the claim to the patient to update COB.

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