Third Party Payment Includes Both Medicare Covered and

40.7.4.2 - Third Party Payment Includes Both Medicare Covered and Noncovered Services (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) To determine the amount of GHP payment for covered services when a bill includes both Medicare covered and noncovered services and it cannot be determined from the GHP's explanation of benefits how much of its payment is for Medicare covered services, the A/B MAC and DME MAC submits the MSP claim to the MSPPAY module which allocates the third-party payment proportionately to the Medicare covered and noncovered services. To do this, it determines the ratio of the charges for covered services to the total charges and multiplies the third-party allowable charge and payment by that ratio. The results are, respectively, the third-party allowable charge and the amount of the third-party payment considered to be for Medicare covered services. The MSPPAY module computes the Medicare secondary payment amount.