Carrier MSPPAY Processing Requirements

50.1.5 - Carrier MSPPAY Processing Requirements (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) The following processing requirements apply: • Process all MSP physician/supplier claims through the MSPPAY software to determine MSP payment amount, at the line level, where applicable, deductible, coinsurance, and savings; • Claims processed by MSPPAY must be in ready-to-pay status, e.g., the amount that Medicare would have paid as the primary payer, the type of MSP situation, the amount of the primary insurer's payment, information regarding outstanding deductible and coinsurance must be available to MSPPAY; and • All data elements required by MSPPAY must be passed to it. Section 50.1.7.A lists these data elements. The Medicare Secondary Payment Technical Manual also contains additional information about them. • The shared systems must accept MSP claims for services at the line level including incoming charges, the OTAF amount, the other payer allowed and paid amounts for incoming MSP claims at the line level. • Forward the service line level amounts to the MSPPAY Module for payment calculation. • Receive the MSP payment at the line level when the completed calculations are returned to the system from the MSPPAY module.