This care may be covered by another payer per coordination of benefits. This denial was received because Medicare records indicate that Medicare is the secondary payer.

To prevent this denial in the future, follow the steps outlined below to determine beneficiary eligibility. If the beneficiary has a primary payer, the claim must be sent to the primary payer for a determination before it is submitted to Medicare for possible secondary payment.

Ask the patient or patient representative to complete the Medicare Secondary Payer (MSP) Questionnaire to help determine if Medicare is the primary or secondary payer. Place the completed questionnaire in the patient’s file.

Check patient eligibility and verify if Medicare is the secondary payer via SPOT or the interactive voice response (IVR) system.

To resolve the denial:

• Refer to the patient’s file and review the MSP questionnaire if it was previously completed.
• Contact the patient or patient representative and ask if insurance has changed. The MSP Questionnaire may be completed again to help determine if Medicare is the secondary payer.
• If the patient’s insurance has changed, note this in the patient’s file for future reference.
• If the patient’s Medicare records need to be updated, the patient should contact the MSP Contractor at 1-855-798-2627.
• If the patient’s file is updated to indicate that Medicare is the primary payer on the date of service, resubmit the claim to Medicare.

• If Medicare is the secondary payer, submit the claim to the primary payer. When the determination is received from the primary payer, submit the claim to Medicare for possible secondary payment.

   

Additional resources to help you prevent this denial:

• First Coast MSP page
• CMS IOM Pub. 10-05 Medicare Secondary Payer, Chapter 2