Instructions to Providers: How to Submit Claims to A/B MACs

30.4 - Instructions to Providers: How to Submit Claims to A/B MACs (Part A) When There Are Multiple Primary Payers (Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23) There are situations where there is more than one primary payer that pays on a Medicare Part A electronic claim and Medicare may still make a secondary payment on the claim. When there are multiple primary payers, providers must do the following when sending the claim to Medicare for secondary payment. • Comply with Section 1.4.2, titled “Coordination of Benefits,” found in the 837 Institutional Implementation Guide regarding the submission of Medicare beneficiary claims to multiple payers for payment. Follow the model that discusses the “provider to payer to provider” methodology of submitting electronic claims. • After receiving the electronic remittance advice from the primary payers, the provider sends the other payers’ claim information to Medicare using the 837 format. For MSP claims, they place the primary payer paid amounts, in loop 2300, qualifier HIXX-1 = BE. The place the value codes in HIXX-2 and the (value code) monetary amounts in HIXX-5. NOTE: In regard to Value Code 44, Obligated to Accept as Payment in Full (OTAF) amount, indicate a value of “Y” in loop 2320, segment OI03. This will inform Medicare that an OTAF amount is present on the claim and the amount can be found in the 2300 loop HI segment. • If, for any reason, providers must send a hardcopy MSP claim, they must place the MSP Value codes and Value code amounts in FL 39-41 of the Form UB04/CMS-1450.