Medicare Secondary Payer (MSP) Provider Duplicate Primary Payment

200.1.6 – Medicare Secondary Payer (MSP) Provider Duplicate Primary Payment (DPP) (Rev. 293; Issued: 09-14-17, Effective: 04-02-18, Implementation: 04-02-18) The contractor shall not process new MSP DPP debts where the debtor is an individual or entity other than the provider; however, contractors shall continue to process provider MSP DPP Debts. The contractors shall separately identify MSP DPP (including provider initiated) debts from all Non-MSP Debts for budget purposes only. Contractors shall process MSP DPP debt as a 935 debt with the exception when the provider requests or initiates the adjustment, it will not be subject to the limitation on recoupment. Note: All MSP DPP debt workload and cost associated need to be accounted for under the MIP funding. 1. All Contractors shall : a) Adjust claims to reprocess as secondary when the Explanation of Benefits (EOB)/primary payment sheet is included with claims. b) Adjust claims to a full claims denial when the EOB/primary payment sheet is not included with the submitted claim(s). i. Contractors shall process these overpayments as any other 935 overpayment in accordance to the procedures outlined in Publication 100.06, Chapters 3, 4 & 5. A. Contractors on HIGLAS shall: Use the existing PART A and PART B MSP Transaction Type Codes for the 935 MSP DPP that was referred to the MAC contractor by the BCRC, CRC, other MAC contractor, or due to Self-Reporting (42 CFR 411.25). They are as follows: 1. MAGHP-PROV935 2. MANONGHP-PROV935 3. MBGHP-PROV935 4. MBNONGHP-PROV935 B. Contractors on HIGLAS shall: Use the transaction types for “Provider Initiated Adjustments” Not Subject to the Limitation on Recoupment. These transaction types will be mapped to APROV1 and BPROV1 letters. 1. (APROV1.pdf): Part A Non-935 Aggregate Demand Letter (To be used for MSP DPP Part A Provider Initiated) • MAGHP-PROV: • MANONGHP-PROV 2. (BPROV1.pdf): Part B Non-935 Initial Letter ( To be used for MSP DPP Part B Provider Initiated) • MBGHP-PROV • MBNONGHP-PROV C. Contractors not on HIGLAS shall: 1. Provider Initiated Overpayments: Refer to Publication 100.6, Chapter 4, §20.1 for Non-MSP / Non-935 demand letter language (Not Subject to Limitation on Recoupment) 2. All other MSP DPP’s : Refer to Publication 100.6, Chapter 4, §20.1 for the Non-MSP 935 Demand Letter Language Use the HIGLAS-CMS Receivable Balance Detail Report (Extract) or CMS Receivable Activity Report to account for all MSP DPP debts under MIP.