Definition of MSP/CWF Terms

10.2 - Definition of MSP/CWF Terms (Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23) Following is a list of terms and their definitions used in MSP/CWF processing. MSP Auxiliary File - Up to 17 beneficiary MSP occurrences/records on the CWF database. MSP Auxiliary Record - Record of beneficiary MSP information. One MSP record/occurrence within the beneficiary's MSP auxiliary file. Occurrence - One MSP occurrence/record within the beneficiary's MSP auxiliary file. MSP Effective Date - Effective date of MSP coverage. MSP Termination Date - Termination date of MSP coverage. Validity Indicator • Y - Beneficiary has MSP coverage (there is a primary insurer for this period of time). • N - No MSP coverage (the N validity indicator is no longer used, but will be seen on older MSP CWF records) • I - See §10.1. • D – Deleted MSP Record MSP Types - Reason for other coverage entitlement. • A = Working Aged • B = End stage renal disease (ESRD) • D = Automobile/Liability No-Fault • E = Workers' Compensation (WC) • F = Federal, Public Health (note: currently not used) • G = Disabled • H = Black Lung (BL) • L=Liability • W=Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) NOTE: VA and other Federal payments are MSP exclusions rather than MSP non- payments. Where the VA authorized services, Medicare does not make payment for items or services furnished by a non-Federal provider pursuant to such an authorization. Although certain MSP billing procedures apply, VA is not an MSP provision. Cost Avoided Claim - A claim returned without payment because CWF indicators indicate another insurer is primary to Medicare. (See Pub. 100-05, Chapter 5 for complete description.) Transaction Type - Identifies type of maintenance record. • 0 = Transaction type to add or change MSP data • 1 = Transaction type to delete MSP data Override Code - Code used to bypass CWF, MSP edit to allow primary Medicare payment. (See §40.4 for a detailed explanation.) MSP Contractor Numbers CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 33333 = Litigation Settlement V 4000 P 55555 = HMO Rate Cell Adjustment U 3000 B,D,T,U,V, or W 77777 = IRS/SSA/HCFA Data Match (I, II, III, IV, V, or VI) Y 1000 Q 88888 = Voluntary Data Sharing Agreements Q 5000 O 99999 = Initial Enrollment Questionnaire T 2000 MSP Contractor Numbers prior to January 1, 2001 CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 0 11100 = MSP Contractor 6000 1 11101 = Initial Enrollment Questionnaire K 6010 2 11102 = IRS/SSA/CMS Data Match E 6020 3 11103 = HMO Rate Cell F 6030 CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 4 11104 = Litigation Settlement G 6040 5 11105 = Employer Voluntary Reporting H 6050 6 11106 = Insurer Voluntary Reporting H 6060 7 11107 = First Claim Development E 6070 8 11108 = Trauma Code Development F 6080 9 11109 = Secondary Claims Investigation G 6090 X 11110 = Self Reports H 7000 Y 11111 = 411.25 J 7010 NOTE: Effective January 1, 2001, the following MSP Contractor numbers and nonpayment/payment denial codes will be used. MSP Contractor Numbers Effective January 1, 2001 CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 0 11100 = MSP Contractor 00 Effective 4/1/2020 6000 1 11101 = Initial Enrollment Questionnaire T 6010 2 11102 = IRS/SSA/CMS Data Match Y 6020 3 11103 = HMO Rate Cell U 6030 4 11104 = Litigation Settlement V 6040 5 11105 = Employer Voluntary Reporting Q 6050 6 11106 = Insurer Voluntary Reporting K 6060 7 11107 = First Claim Development E 6070 8 11108 = Trauma Code Development F 6080 CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 9 11109 = Secondary Claims Investigation G 6090 10 - Effective 4/1/2002 11110 = Self Reports H 7000 11 - Effective 4/1/2002 11111 = 411.25 J 7010 11101, 11102, 11103, 11104, and 11105 use the same non-payment denial codes as their previous contractor numbers (i.e., 33333, 55555, 77777, 88888, 99999). Savings from the old and new numbers, if applicable will be reported together (e.g., 11101 and 99999, etc). There must be a conversion of the MSP savings to the new non- payment/payment denial codes as of January 1, 2001. Additional MSP Contractor Numbers Effective April 1, 2002 Effective April 1, 2002, CWF is expanding the source code field and the nonpayment/ payment denial code field from 1-position fields to 2-position fields. CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 12 11112 = Blue Cross-Blue Shield Voluntary Data Sharing Agreements 12 7012 13 11113 = Office of Personnel Management (OPM) Data Match 13 7013 14 11114 = State Workers' Compensation (WC) Data Match 14 7014 15 11115 = WC Insurer Voluntary Data Sharing Agreements (WC VDSA) 15 7015 16 11116 = Liability Insurer Voluntary Data Sharing Agreements (LIAB VDSA) 16 7016 17 11117 = Voluntary Data Sharing Agreements (No Fault VDSA) 17 7017 CWF Source Codes MSP Contractor Numbers Non- payment/ Payment Denial Codes CROWD Special Project Numbers 18 11118 = Pharmacy Benefit Manager Data 18 7018 19 11119 = Workers’ Compensation Medicare Set-Aside Arrangement 19 7019 20 11120 = COBA 20 N/A 21 11121= MIR Group Health Plan 21 7021 22 11122= MIR Non-Group Health Plan 22 7022 23 11123 = To be determined 23 7023 24 11124 = To be determined 24 7024 25 11125 = Recovery Audit Contractor-California 25 7025 26 11126 = Recovery Audit Contractor-Florida 26 7026 27 11127 = To be determined 27 7027 “” “” “” “” 39 11139 = GHP Recovery 39 7039 41 11141 =NGHP Non Ongoing Responsibility for Medicals (ORM) 41 7041 42 11142 = NGHP ORM Recovery 42 7042 43 11143 = MSP Contractor /Medicare Part C/Medicare Advantage 43 7043 “” “” “” “” 99 11199 = To be determined 99 7099