Quick reference chart for Medicare Secondary Payer (MSP) claims
| Data Element | Definition | 837 Version 5010 Loops/Elements | 1500 Claim Form | Required/Conditional |
|---|---|---|---|---|
| MSP Insurer Type | Code identifying the type of insurance primary to Medicare (see key below) | 2000B/Elem SBR05 | Attach Primary Insurer's EOB | R |
| Patient Relationship | Code specifying the relationship to the person insured (see key below) | 2320/Elem SBR02 | Item 6 | R |
| Subscriber Name | Name of the individual insured | 2330A/Elem NM103, NM104 | Item 4 | R |
| Insurer Group Number | Group policy number | 2320/Elem SBR03 | Item 9a | Report if known |
| Insurer Name | Name of insurance carrier | 2330B/Elem NM103 | Item 11c | R |
| Insurer Address | Address of insurance carrier | 2330B/Elem N301, N401, N402, N403 | Attach Primary Insurer’s EOB, be sure to add the address if not available on the EOB. | R |
| Policy Number | Subscribers' policy/member ID number | 2330A/Elem NM109 | Item 11 | Report if known |
| Date of Accident/Injury | Date the accident/injury occurred | 2300/Elem DTP03 | Item 14 | C |
| Payer Paid Amount | The amount paid by the primary insurer | Claim=2320 AMT02 or line=2430/Elem SVD02 (report at line level unless lump sum payment) | Attach Primary Insurer’s EOB | R |
| Patient Liability Amount | The amount the patient is liable for | Claim=2320 AMT02 or line=2430/Elem AMT02 (report at line level unless lump sum payment) | Attach Primary Insurer’s EOB | R |
| Adjustment Group Code | The code to identify who is responsible for the claim adjustment amount. (CO, PR, OA) | Claim=2320 CAS01 or line=2430/Elem CAS01 (report at line level unless lump sum payment) | Attach Primary Insurer’s EOB | R |
| Claim Adjustment Reason Code (CARC) | The code identifying the reason the adjustment was made. A detailed list is available on the Washington Publishing Company website. |
Claim=2320 CAS02 or line=2430/Elem CAS02 (report at line level unless lump sum payment) | Attach Primary Insurer’s EOB | R |
| Monetary Amount | The amount of the adjustment. | Claim=2320 CAS03 or line=2430/Elem CAS03 | Attach Primary Insurer’s EOB | R |
Note: The primary insurer's EOB should never be submitted for electronic claims submissions.
MSP insurer type codes
Many MSP claims are submitted with the incorrect insurance type reported. It is important to report the correct MSP insurance type on a claim to avoid claim rejections. Reference the chart below for the two-digit MSP insurer type and a brief description of the MSP provision.
| MSP insurer type | MSP provision |
|---|---|
| 12 | Working Aged Beneficiary or Spouse with Employer Group Health Plan (EGHP) |
| 13 | End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer’s Group Health Plan (EGHP) |
| 14 | No-fault Insurance including Auto is Primary |
| 15 | Worker’s Compensation |
| 16 | Public Health Service (PHS) or Other Federal Agency |
| 41 | Black Lung |
| 43 | Disable Beneficiary Under Age 65 with Large Group Health Plan (LGHP) |
| 47 | Liability Insurance |
MSP patient relationship codes
| Patient relationship code | Definition |
|---|---|
| 01 | Spouse |
| 18 | Self |
| 19 | Child |
| 20 | Employee |
| 21 | Unknown |
| 53 | Life Partner |
| G8 | Other Relationship |