MSPPAY "Driver" Module

50.2.2 - MSPPAY "Driver" Module (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) MSPPAY, the "Driver Module," makes the determination based on the service "thru- date" on the bill to call one of the following MSP sub-modules to process the payment calculations: A. MSPPAYAI MSPPAYAI calculates payment for inpatient, skilled nursing facility (SNF), and religious nonmedical health care (RNHC) bill types. B. MSPPAYOL MSPPAYOL calculates payment at the service line level for outpatient bill types. (See §50.2.8). Accepts data from MSPPAY and apportions the primary payer's paid amount and obligated to accept as payment in full (if applicable) based on the ratio computed by the Total Medicare Covered Charges for each service line divided by the Total Medicare Covered Charges. It calls MSPPAYAO to calculate the claim by line. C. MSPPAYAO MSPPAYAO calculates payment for outpatient, home health agency (HHA), and hospice bill types MSPPAY receives bill data from the A/B MACs (Part A) and A/B MACs (HHH) system and performs the following processes: A. Performs validity edits on the sending field "THRU-DATE" • Century value must be "19" or "20" • Year value must be "00" thru "99." • Month value must be "01" thru "12." • Day value must be "01" thru "31." B. Performs validity edits on the sending field RECORD-ID • HMIP = Inpatient/SNF/CSS bills • HMOL = Outpatient claims by line • HMOP = Outpatient bills • HMHH = Home health bills • HMHC = Hospice claim C. Calls the appropriate MSP payment sub-modules • MSPPAYAI for bill service with RECORD-ID of HMIP; and • MSPPAYAO for bill service with RECORD-ID of HMOP, HMHH, or HMHC • MSPPAYOL for claim service with RECORD-ID of HMOL D. Returns appropriate status codes along with the MSP computation and savings data to the A/B MACs (Part A) system See §50.2.3 below for an explanation of return codes. Once MSPPAY passes back information to the A/B MACs (Part A) and A/B MACs (HHH) claims processing system, the data can be retrieved in any format desired, e.g., savings reports, management tools, and MSN generation. The reports can be tailored to the A/B MACs (Part A) specific needs.