Payment Calculation Processes for MSP Claims

50.2.1 - Payment Calculation Processes for MSP Claims (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) The following payment calculation processes are performed for a complete Medicare secondary payer bill. • Apportions the primary payer's paid amount and obligated to accept as payment in full (if applicable), for outpatient services, based on the ratio computed by the Total Medicare Covered Charges for each service line divided by the Total Medicare Covered Charges; • Computes the Medicare secondary payment amount, applicable deductible, and coinsurance amounts; • Reduces benefit utilization (if applicable); and • Computes Medicare secondary savings. MSPPAY is the "driver" module in the above processes.