Correct reporting of MSP type on electronic claims

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Home ► MSP ► Correct reporting of MSP type on electronic claims

Last Modified: 8/31/2022 Location: FL, PR, USVI Business: Part B

Correct reporting of MSP type on electronic claims

Please take a few minutes to ensure you obtain Medicare secondary payer (MSP) insurance information and report the correct corresponding MSP type on your Medicare secondary claim submissions. Effective for claims processed on or after April 27, 2017, failure to supply the correct MSP type will result in a return unprocessable claim (RUC) denial with claim adjustment reason code (CARC) code 16 and remittance advice remark code (RARC) N245. These messages indicate the claim information was reported incorrectly and you must submit a new claim with the correct MSP type.

When submitting an electronic claim to Medicare, you are required to obtain MSP insurance information from the patient. The patient’s insurance is classified as either a group health plan (GHP) or a non-group health plan (NGHP). Examples of GHP coverage are working aged (WA), disability, or end-stage renal disease (ESRD). These types of coverage are based on current or past employment. Examples of NGHP coverage are automobile/no-fault, workers’ compensation (WC), and liability. These types of coverage are typically the result of an accident, injury, or lawsuit. Although there are other types of MSP coverage, these are the most common.

We receive many MSP claims with the incorrect insurance type reported. It is extremely important to report the correct MSP insurance type on a claim. Some examples of incorrect MSP insurance types are:

• Reporting MSP type 47 (liability) as a default code

• Reporting MSP type 12 (WA) instead of 43 (disability) or 13 (ESRD)

Please reference the chart below for the two-digit MSP insurance type and a brief description of the MSP provision.

MSP insurance type	GHP or NGHP	MSP provision
12	GHP	Working aged – Beneficiaries age 65 or older who are insured through their own or their spouse’s current employment. The beneficiary must be aged 65 or older. There must be at least 20 or more employees.
43	GHP	Disability – This coverage is for beneficiaries who are under age 65 and disabled. Insurance is based on their own current employment or through the current employment of a family member. There must be 100 or more employees.
13	GHP	End-stage renal disease – This coverage is for beneficiaries enrolled with Medicare solely due to renal failure and are insured through their own, or through a family member’s current or former employment. Medicare is secondary payer for the first 30 months. There is no age restriction on this type of coverage. The beneficiary may be under or over age 65.
14	NGHP	Automobile/no-fault – No-fault insurance that pays for medical expenses for injuries sustained from a motor vehicle accident. This coverage is not based on employment.
15	NGHP	Workers’ compensation – This is insurance that employers are required to provide employees that become ill or injured on the job.
47	NGHP	Liability – Insurance (including a self-insured plan) that provides payment based on the policyholder’s alleged legal liability for injury, illness or damage to property. Some examples of this coverage could be product liability, malpractice, and homeowner’s coverage.

For more information on how to submit electronic MSP claims and where to indicate the MSP type, please review Billing the correct Medicare secondary payer insurance type code.

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