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MSP (Medicare secondary payer)

News
Modified: 8/15/2021
This article contains important information about a revision being made to Medicare secondary payer (MSP) claim editing.
Please review this article for details on how to properly bill Medicare secondary payer (MSP) and conditional payment request claims on 837 institutional claims, and the use of occurrence code (OC) 24 and date of denial.
More
Interactive tools
Calculators
more ESRD coordination period calculator -- determine a beneficiary's ESRD (end-stage renal disease) coordination period.
more Reason code lookup – locate descriptions associated with Medicare Part A reason codes.
MSP billing and claims
more MSP value codes and payer codes -- Learn the correct pairing of value codes (VC) and payer codes (PC) to use when billing different types of Medicare secondary payer (MSP) claims.
more MSP interactive billing tool simulation flash file -- this simulation assists in determining if Medicare is primary.
more Electronic filing of MSP claims -- find information for filing MSP claims in the 5010 format
more Requesting MSP conditional payments -- Providers may file a MSP claim and request a conditional payment for a Medicare-covered service when another payer is responsible for payment and is not expected to pay promptly.
more MSP and conditional payment request claim filing guidelines -- Learn how to properly bill MSP and conditional payment request claims on 837 institutional claims, and the use of occurrence code (OC) 24 and date of denial.
more Limitations on ESRD coverage by certain health care plans -- this article refers to denials when Medicare is the secondary payer during the coordination period of 30 months required for beneficiaries that are eligible for Medicare due to an ESRD diagnosis.
Claims data
Denials, RTPs and rejects
more Resources/tips to avoid or correct reject reason code 34538
more Resources/tips to avoid or correct reject reason code 34540
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Part A