Federal (United States) · Agency guidance
Chapter 5
154 sections
154 sections
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10Coordination with the MSP Contractor
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.1A/B MACs and DME MACs Contractor MSP Auxiliary File Update
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.2MSP Contractor Electronic Correspondence Referral System (ECRS)
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.2.1ECRS Functional Description
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.3Providing Written Documents to the MSP Contractor
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.4Contractor Record Retention
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.5Notification to A/B MACs and DME MACs of MSP Auxiliary File Updates
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.6Referring Calls to the MSP Contractor
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.7Additional Activities Arranged by Non-GHP MSP Type
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.7.1No-Fault Development
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.7.2Workers' Compensation (WC) Development
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.7.3Liability Development
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.8MSP Contractor Numbers
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.8.1No-Fault Development
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.8.2Workers' Compensation (WC) Development
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 10.8.3Liability Development
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20Sources That May Identify Other Insurance Coverage
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.1Identification of Liability and No-Fault Situations
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.2Identify Claims with Possible WC Coverage
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.3Medicare Claims Where Veterans' Affairs (VA) Liability May Be Involved
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.3.1VA Payment Safeguards
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.4Identification of On-Going Responsibility for Medicals (ORM) in Liability,
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.4.1Background Regarding ORM for A/B MACs and DME MACs
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.4.2Policy Regarding ORM
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.4.3Operationalizing ORM for Liability, No-Fault and Workers’
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 20.5Medicare Residual Payments Due When On-going Responsibility for
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30Develop Claims for Medicare Secondary Benefits
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.1Further Development Is Not Necessary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.2Further Development Is Required
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.3GHP May Be Primary to Medicare
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.3.1Develop ESRD Claims Where Basis for Medicare Entitlement Changes
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.4Workers' Compensation Responses
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.4.1Patient Receives Concurrent Services Which Are Not Work-Related
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.5No-Fault Responses
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.5.1No-Fault Insurer Denies That It Is the Primary Payer
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.5.2No-Fault Insurance Does Not Pay All Charges Because of a Deductible or
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.5.3State Law or Contract Provides That No-Fault Insurance Is Secondary to
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 30.6Liability Claim Is Filed and There is Also Coverage Under Automobile or
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40A/B MACs (Part A), A/B MACs (Part B), A/B MACs (Part HHH), and DME MACs
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.1Claim Indicates Medicare is the Primary Payer
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.1.1Facts Indicate Reasonable Likelihood of Workers' Compensation
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.1.1.1The Beneficiary Is on the Black Lung Entitlement Rolls
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.1.2Services by Outside Sources Not Covered
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.1.2.1Exception
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.1.3Notice to Beneficiary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.2Update CWF MSP Auxiliary File
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.2.1Action if Payment Has Been Made Under No-Fault Insurance
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.3Processing Part B Claims Involving GHPs
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.3.1GHP Denies Payment for Primary Benefits
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.3.2GHP Does Not Pay Because of Deductible or Coinsurance Provision
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.3.3GHP Gives Medicare Beneficiary Choice of Using Preferred Provider
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.4GHP Pays Primary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.4.1GHP Pays Charges in Full
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.4.2GHP Pays Portion of Charges
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.4.3GHP Pays Primary Benefits When Not Required
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.5Primary Payer Is Bankrupt or Insolvent
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.5.1Billing Beneficiaries During the Liquidation Process
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.5.2When to Make a Medicare Secondary Payment
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.5.3Amount of Secondary Payment
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.5.4Time Limits for Filing Secondary Claims After Liquidation Process
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.6Conditional Primary Medicare Benefits
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.6.1Conditional Medicare Payment
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.6.2When Primary Benefits and Conditional Primary Medicare
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7A/B MACs (Part B) and DME MACs Processing Procedures for
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.1Crediting the Part B Deductible
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.2Medicare Payment Calculation Methodology
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.3Medicare Secondary Payment Calculation Methodology for
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.3.1Medicare Secondary Payment Part B Claims Determination for
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.3.2Medicare Secondary Payment Part A Claims Determination
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.3.3Version 5010 Balancing for Incoming ASC X12 837 MSP
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.4Effect of Medicare Limiting Charge on Medicare Secondary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.4.1GHP Does Not Pay for Certain Services
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.4.2Third Party Payment Includes Both Medicare Covered and
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.5Effect of Failure to File Proper Claim
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.6Medicare Secondary Payment for Managed Care Organizations'
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.7.7MSP Situations Under CAP
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8A/B MAC (Part A) Processing Procedures for Medicare
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.1Medicare Secondary Payment Calculation Methodology When
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.2Rule to Determine the Amount of Secondary Benefits
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.3Application of the MSP Formula
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.4Provider Interim Payment (PIP) Reduction
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.5MSP Part B Claims (Outpatient and Other Part B Services,
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.6MSP Outpatient Claims Involving Lab Charges Paid by Fee
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.6.1Prorating Primary Payments
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.6.2Calculation of Deductible and Coinsurance
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.7Calculating Medicare Secondary Payments When Proper Claim
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.8Determining Patient Utilization Days, Deductible, and
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.9Benefits Exhausted Situations When Medicare Is Secondary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.10Deductible and/or Coinsurance Rates Spanning Two Calendar
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.11Submit Data to CWF When Full Payment Made by Primary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 40.8.12Submit Data to CWF When Partial Payment Made by Primary
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50MSP Pay Modules to Calculate Medicare Secondary Payment
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1Medicare Secondary Payer (MSP) Payment Modules (MSPPAY)
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.1Payment Calculation Processes for MSP Claims
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.2MSPPAY "Driver" Module
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.3Return Codes
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.4Executing and Testing MSPPAY Software
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.5Carrier MSPPAY Processing Requirements
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.6Error Resolution
- Medicare Secondary Payer Manual (Pub. 100-05), Ch. 5 § 50.1.7Payment Calculation for Physician/Supplier Claims (MSPPAYB