Appeals Procedures for MSP Liability and Waiver Determinations

40.21 – Appeals Procedures for MSP Liability and Waiver Determinations (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) These instructions prescribe procedures to be used in processing appeals of: 1) MSP liability determinations (including Non-Group Health Plan (NGHP) debt, beneficiary debt, and insurer debts created after 4/28/2015 (following implementation of the Strengthening Medicare and Repaying Taxpayers Act of 2012); and 2) MSP waiver determinations. Since recovering MSP liability determinations involves procedures which vary somewhat from those used for general Medicare overpayments, the following recovery instructions are to be used in place of the general overpayment instructions found in the Medicare Claims Processing Manual (Chapter 29, Appeals of Claims Decisions), except where specific references to those sections are provided. These instructions supersede any conflicts in the procedures.