Last Modified: 7/1/2020
Location: FL, PR, USVI
Business: Part A, Part B
Q: What types of insurance plans are displayed in MSP? If a beneficiary has coverage that is primary to Medicare, why would some or all of the information about the primary payer not be displayed in the MSP option under Benefits/Eligibility?
A: The types of primary insurance plans that may be displayed under the MSP option include:
• 12: Medicare Secondary Working Aged Beneficiary or spouse with Employer Group Health Plan
• 13: Medicare Secondary End Stage Renal Disease Beneficiary in the coordination period with an Employer Group Health Plan
• 14: Medicare Secondary No-Fault insurance including auto is primary
• 15: Medicare Secondary Workers’ Compensation
• 16: Medicare Secondary Public Health Service (PHS) or other
• Federal agency
• 41: Medicare Secondary Black Lung
• 42: Medicare Secondary Veteran’s Administration
• 43: Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan
• 47: Medicare Secondary other liability insurance is primary
• WC: Workers’ Compensation Medicare Set-aside Arrangement
The MSP submenu option displays data regarding a beneficiary’s coverage that is primary to Medicare. However, the SPOT will only display active MSP data of which the Centers for Medicare & Medicaid Services (CMS) has been notified. If no active data is available, the MSP option will appear grayed out on the screen as is the ‘Hospice/Home Health’ data in the above image.
It is the responsibility of the insurer to notify the SSA of the coverage and of any information associated with the primary payer (e.g., type of primary insurance, policy number, name of insurer). Once the SSA has been notified, the information will be shared with CMS’ systems, including its HIPAA Eligibility Transaction System (HETS).
Since HETS is the source for all eligibility data accessed from the SPOT, the portal will display only data that is contained within the system.
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