MSP Cost Avoided Claims

40.5 - MSP Cost Avoided Claims (Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23) A/B MACs and DME MACs shall follow the instructions cited in Pub. 100-05, Chapter 5 for counting savings on MSP cost avoided claims. They shall submit ALL MSP cost avoided claims to CWF. Payment/Denial codes are used to identify the reason a claim was denied. Specific codes for MSP are listed and defined in §10.2 under the MSP/ Contractor Number chart in that section. A/B MACs (Part B) and DME MACs submit the appropriate code to CWF in the Health Utilization Part B Claim ("HUBC") claim record in field 63 "Payment/Denial Code" for line item denials. They complete the appropriate code for full claim denials in the "HUBC" claim record, field 16 "Payment/Denial". A/B MACs (Part A) submit the appropriate code in the Health Utilization Inpatient Claim (HUIP) CWF record field 58 "Nonpayment" code for inpatient hospital and SNF claim denials. They submit the appropriate code in field 59 "No Pay Code" of the CWF record for the specific type of claim identified in the chart below. PAYMENT/DENIAL CODE FIELDS IN CWF CLAIM RECORD Contractor Type of Claim CWF Record Field A/B MAC (Part B) and DME MAC Full Claim Denial HUBC 16 Payment/Denial A/B MAC (Part B) and DME MAC Full Line Item Denial HUBC 63 Payment/Denial Code A/B MAC (Part A) and DME MAC Inpatient hospital and inpatient SNF Denial HUIP 58 Nonpayment Code A/B MAC (Part A) and DME MAC Health Utilization Outpatient (HUOP) HUOP 59 No Pay Code A/B MAC (HH&H) Health Utilization Home Health (HUHH) HUHH 59 No Pay Code A/B MAC (HH&H) Health Utilization Hospice Claim (HUHC) HUHC 59 No Pay Code If a denial indicator is incorrect, the CWF software will correct the denial indicator based on the matching MSP auxiliary record and send the correct value back to the contractor on the response record header. It is not necessary for an MSP auxiliary record to be present in order to post MSP cost avoided savings. If one is present, the A/B MAC or DME MAC uses the "X" or "Y" override code as appropriate.