Develop Claims for Medicare Secondary Benefits

30 - Develop Claims for Medicare Secondary Benefits (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) When Medicare is indicated as primary payer on a claim, assume, in the absence of evidence to the contrary, that the provider has correctly determined that there is no other primary coverage and process the claim accordingly. There are instances in which further development is necessary, as discussed in §30.2. Under the COB contract, the MSP Contractor is responsible for developing whether there is a payer primary to Medicare. The A/B Medicare Administrative Contractors (MACs) (Part A), A/B MACs (Part B), or A/B MACs (Part HHH) (collectively referred to as A/B MACs) and Durable Medical Equipment MACs (DME MACs) supplies the MSP Contractor information via ECRS or by telephone or fax, depending on circumstances. The A/B MAC and DME MAC obtains the MSP data needed to process claims via CWF, which the MSP Contractor updates with the results of its investigations. There is some minimal provision for the A/B MAC and DME MAC to update the MSP auxiliary file on CWF with MSP information. See §10.1, above.