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Medicare Secondary Payer FAQ

When billing a conditional payment electronically, what code(s) are required to process the claim correctly?

As of February 10, 2003, occurrence code 24 and the date of the denial are required on the claim requesting a conditional payment. Additionally, the appropriate MSP value code and zero dollar amount is required on the claim. (7/6/2007)

What are the correct payer codes and value codes for the Medicare Secondary Payer provisions?

The following table will provide the appropriate value codes, payer codes and occurrence codes for Medicare Secondary Payer provisions. (9/1/2003)

Description	Payer Code	Value Code	Occurrence Codes
Working Aged	A	12	N/A
ESRD	B	13	33
No-Fault	D	14	01 and 02
Worker's Compensation	E	15	04
Public Health System	F	16	N/A
Black Lung	H	41	C
Veteran's Administration	I	42	N/A
Disability	G	43	N/A
Liability	L	47	01 and 03

What are the reasons a Medicare Secondary claim is returned for correction?

The following table provides the top five reasons an MSP claim would be returned for correction. (9/1/2003)

Hardcopy submitted claims	Electronically submitted claims
1. Field 12 and field 58 on the UB 92 do not match.	1. No MSP value code has been entered in fields 39-41 on the UB 92.
2. Field 58 through 60b on the UB 92 are missing.	2. There is no value code, no amount and no occurrence code 24 present on the claim.
3. The facility Provider Transaction Access Number (PTAN) has been entered on the wrong line.	3. Amount due from the patient matches the MSP value code amount.
4. Medicaid has been entered in field 50 line A on the UB 92.	4. The claim contains an invalid or missing diagnosis code.
5. The claim does not have payer information entered in the payer block labeled as field 50 on the UB 92.	5. The claim does not have the physician UPIN and/or physician name.

What is the Coordination of Benefits (COB) Contractor?

The COB Contractor is responsible for all initial Medicare Secondary Payer (MSP) development activities. All MSP claims investigations are initiated from and researched by the COB Contractor. The COB Contractor provides customer service to all callers from any source (beneficiary, provider, etc). The toll-free COB Call Center telephone number is 800-999-1118, hours of operation are 8 AM-8PM, Monday - Friday EST. See http://www.cms.hhs.gov/COBGeneralInformation/03_ContactingtheCOBContractor.asp (7/6/2007)

How do I bill a conditional MSP claim?

Use the appropriate MSP value codes (UB-04 fl 39-41), which are 12, 13, 14, 15,16 or 41, 43, 47. with zero value ($0.00)in the dollar amount field. Enter appropriate occurrence codes and, in addition, an explanation of why the conditional payment is justified should be entered in the Remarks field. (7/6/2007)

Does the COB Contractor process claims?

No, the COB Contractor will not be processing any claims, nor will it handle any claim specific inquiries. (7/6/2007)

Our facility is experiencing problems with the patient relationship codes and our claims are returning to us for correction with reason code 16604. What do we need to do to correct this problem?

CMS must ensure that the appropriate patient relationship codes are paired with their corresponding MSP Type Codes for purposes of creating accurate MSP auxiliary records. As instructed in CR 3116 facilities should be submitting correct patient relationship codes in accordance with the HIPAA guidelines. The following link will direct you to the Change Request http://www.cms.hhs.gov/transmittals/Downloads/R9MSP.pdf (7/6/2007)