MSP Add Transaction

20.1.1 - MSP Add Transaction (Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23) The two situations in which the "add" maintenance transaction is used are: • There is no MSP auxiliary file record for a beneficiary. In this case, the "add" transaction creates an MSP auxiliary record containing the new MSP transaction and sets the MSP indicator on the beneficiary's master record; or • There is an MSP auxiliary file record but no matching occurrence for the beneficiary. In this case, the "add" transaction adds the maintenance transaction as a new occurrence. The following fields are mandatory for a validity indicator of "Y" or "I" (Another insurer is responsible for payment): • Medicare beneficiary identifier; • MSP type (MSP code); • Validity indicator; • MSP effective date; • Contractor identification number; • Insurer name (CWF will allow a space in the second position provided the third position contains a valid character other than a space.); • Patient relationship; and • Insurance type. A "Y" or "I" record CANNOT be established without the insurer name. Note, if the Insurance Company Name is blank, or contains one of the abbreviated values that should not be used as found in the ECRS manual, then it is considered an error. NOTE: Although the insurer address cannot be MANDATORY, it should be provided whenever possible. The following are to be used as default values when creating an “I” record: (1) MSP Effective Date: Use the Part A entitlement date. (2) Patient Relationship: Use “01” if there is no indication of other insured member, and use “02” if another member is shown, but uncertain of relationship. (3) MSP Type: For GHP, use the current reason for entitlement: working aged (12), disability (43), or ESRD (13). For NGHP, if not identified, the default to be used is No- Fault (14).