Payment Calculation Processes for MSP Claims

50.1.1 - Payment Calculation Processes for MSP Claims (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) For a valid Medicare secondary payer Part B claim, the Part B MSPPAY module performs the following payment calculation processes: • Apportions the primary payer's paid amount, the other payer's allowed amount and obligated to accept as payment in full (if applicable), based on the ratio computed by the total amount billed for each service divided by the total billed amount, if line item information is not supplied by the primary payer. • Computes the Medicare secondary payment amount for assigned and unassigned claims by line; and Computes Medicare secondary savings.