No-Fault Insurer Denies That It Is the Primary Payer

30.5.1 - No-Fault Insurer Denies That It Is the Primary Payer (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) Denial by an insurer on the basis that Medicare is the primary payer may be a forerunner of similar action on multiple claims. Advise the MSP Contractor of this circumstance via ECRS if the CARC shows a valid reason why the claim was denied; e.g., benefits were exhausted or other reasons as described in the IOM or CMS CRs such as CMS CRs 6426 and 6427 including subsequent CRs. The MSP Contractor is responsible for any needed follow-up action with the no-fault insurer. See sections 40.6 and 40.6.1 for reasons why the NGHP insurer may deny the claim and that Medicare may make a conditional payment.