Workers' Compensation Responses

30.4 - Workers' Compensation Responses (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) If the MSP Contractor investigation indicates that WC benefits should be paid for the services, the A/B MAC and the DME MAC denies benefits and notifies the claimant that Medicare benefits are not payable for services covered under WC. It advises the claimant to file a claim with WC, and, if a WC claim is filed and denied, the Medicare claim may be reopened. It further advises the claimant that if the reason for denial of WC benefits is due to the claimant's failure to timely file a claim, Medicare payment will not be made and the A/B MAC and the DME MAC documents the determination. When Medicare benefits are denied because all or part of the services are reimbursable under the Black Lung (BL) program, by virtue of the diagnosis codes submitted, the A/B MAC and the DME MAC advises the claimant to submit a claim to: U.S. Department of Labor OWCP/DCMWC P.O. Box 8307 London, KY 40742-8307 The A/B MAC and the DME MAC advises the claimant that Medicare cannot pay for the services, because the Federal Black Lung program, administered by DOL, pays primary to Medicare. However, if DOL does not pay for all services, the claimant or provider of service should resubmit the claim to the A/B MAC and the DME MAC with a copy of DOL's explanation of its payment.