Riverbend

Helpful Tips

This Helpful Tips section is designed to help you with your claims process as you file for secondary costs to be paid by Medicare.  While this is not an exhaustive list, we do hope you will find it useful.  Please refer to the See Also section at the bottom of the page to link to other relative resources including Riverbend’s primary MSP page and MSP Questionnaire.

Payer Provision	Payer ID	Occurrence Code	Occurrence Code	Value Code	Description	Value Code	Description
Working Aged	A	N/A	N/A	12	This code and corresponding amount reflect the EGHP payment	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
ESRD	B	33 & date	N/A	13	This code and corresponding amount reflect the portion of the higher priority EGHP payment made on behalf of an ESRD beneficiary	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Conditional Payment	C	24		Append the appropriate value code	Add remarks in field 84 on the hardcopy claim on page 4 through Direct Data Entry why the primary denied.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Auto/No Fault	D	'01 & date of accident	'02 & date of accident	14	This code and corresponding amount reflect the no-fault (including auto or other) insurance payment made on behalf of the patient or insured.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Auto Liability	L	'01 & date of accident	'03 & date of accident	47	This code indicates the amount shown is that portion from a liability insurance made on behalf of a Medicare beneficiary that the provider is applying to Medicare covered services on the bill being submitted.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Workers’ Comp	E	04 and date	03	15	The code and corresponding amount reflect the WC insurance payment made on behalf of the patient or insured.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Disability	G		N/A	43	This code and corresponding amount reflect the LGHP payment made on behalf of a disabled beneficiary that the provider is is applying to Medicare covered services on this bill.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Black Lung	H	N/A	N/A	41	This code and corresand corresponding amount reflect the federal BL program payment made on behalf of the Medicare beneficiary.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.
Veteran's Administration	I	N/A	N/A	42	This code and corresponding amount reflect the VA payment made on behalf of the Medicare beneficiary.	44	This code and corresponding amount indicates the amount the provider was obligated or required to accept from a primary payer.

MSP Claim Locators
Field Locator (FL) 24-30    Condition Codes
FLs 32-35                          Occurrence Codes
FLs 39-41                          Value Codes
FLs 50                                Payer Identification
FLs 58-62                           LGHP Information
FLs 65-66                           Employer Information
FL 84                                  Remarks

Conditional Claims:
1. Use the value code appropriate for the MSP provision type.
2. Use the occurrence codes appropriate to your MSP provision type.
3. ADD the occurrence code 24 with the date of denial

Only file conditional claims if you have not received payment from the primary payer.

Occurrence Code 05:
1. Determine if the accident could involve other insurance or a lawsuit. 
         a)   If it does, do not use the occurrence code 05.  Bill the claim conditionally with all of the
               information. 
         b)   If it does not involve a third party insurance and there is no medical payment, bill the claim with occurrence code 05 and document in remarks the reason for the patient's visit.

 Use the occurrence code 05 with the date of service if the diagnosis codes are not accident related.

Other Tips

When filing a Medicare Secondary Payer claim ensure field 50 line A is the primary payer also include the policy number for the insured.  Remember to complete the patient relationship field.

Additional Information

Condition Codes		Occurrence Codes		Value Codes
02	Condition is employement related	01	Auto Accident	12	Working Aged Beneficiary/spouse with a GHP
05	Lien has been filed	02	No-fault insurance including auto accident/other	13	ESRD beneficiary in a Medicare coordination period with a GHP
06	ESRD	03	Accident/tort liability	14	No-fault, including auto/other insurance
08	Beneficiary would not provider information concerning other insurance coverage	04	Accident/employment related	15	Workers’ Compensation (WC)
09	Neither patient nor spouse is employed	05	Other accident	16	PHS, other federal agency
10	Patient and/or spouse is employed, but no GHP coverage exists	18	Date of retirement	41	Black Lung
11	Disabled beneficiary, but no LGHP coverage	19	Date of retirement spouse	42	VA
26	VA eligible patient chooses to receive services in a Medicare certified facility	24	Date insurance denial	43	Disabled beneficiary under age 65 with GHP
28	Patient and/or spouse’s GHP is secondary to Medicare	25	Date benefits terminated by primary payer	44	Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received
29	Disabled beneficiary and/or family member’s LGHP is secondary to Medicare	33	First day of the Medicare coordination period for ESRD beneficiaries covered by GHP	47	Any liability insurance
77	Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer in full

Disclaimer: This list is not all-inclusive.  To review all data elements please see Internet Only Manual (IOM) Pub 100-04, Chapter 25: Completing and Processing UB-92 (CMS-1450) Data Set (http://www.cms.hhs.gov/manuals/downloads/clm104c25.pdf).
This document will not ensure payment and is for instructional purpose only. The Web site address should be reviewed along with the documentation before bill.

See Also:

MSP Questionnaire 

MSP Home