G Controls – Medicare Secondary Payer (MSP)

50.7 – G Controls – Medicare Secondary Payer (MSP) (Rev. 10614, Issued: 03-23-21, Effective: 10-01-20, Implementation: 04-22-21) G – Control Number Control Objective – Medicare Secondary Payer (MSP) G.1 Medicare Administrative Contractor internal quality controls are established and maintained that ensure timely and accurate processing of secondary claims submitted, including paper MSP claims with a primary payer’s explanation of benefits (EOB) or remittance advice (RA). This includes utilization of the MSPPAY module, resolving all MSP edits (including 6800 codes*), creation of “I” records and resolving suspended claims in accordance with CMS instructions at Publication 100-05 Chapter 5 and 6. Contractor internal systems used to process MSP claims are updated via the Common Working File (CWF) automatic notice in an automated fashion. Suspended claims that require manual intervention are corrected and reviewed by the appropriate suspense staff. This control objective does not pertain to BCRC or the CRC contractors. G – Control Number Control Objective – Medicare Secondary Payer (MSP) G.2 Audit trails for MSP receivables are created and maintained. An audit trail should include details of the source of the receivable, correspondence in date order, reasons for adjustments, referral to treasury, collection of the debt, and any information regarding the establishing, reconciling and resolving a receivable for an outstanding debt. All applicable systems (e.g. HIGLAS) should be updated accurately and timely, and be accessible to the appropriate individuals. This control objective pertains to MACs, BCRC, and CRC Contractors. G.3.1 Contractors ensure compliance with all CMS instructions and directives relating to MSP Investigations by the Benefit Coordination & Recovery Center (BCRC). This includes the MACs transmitting appropriate, timely and complete Electronic Correspondence Referral System (ECRS) submissions in accordance with Publication 100-05, CWF Assistance Requests and ECRS MSP inquiries to the BCRC as a result of the receipt of a phone call, correspondence, claim or unsolicited check/voluntary refund. All references must be maintained in an area accessible to MSP staff and must be available for CMS review. *The ECRS user guide is located at: Publication # 100-05 The Electronic Correspondence Referral System on the Web (ECRS Web) User Guide. This control objective does not pertain to the CRC Contractor G.3.2 The Commercial Repayment Center (CRC) must transmit appropriate, timely and complete ECRS submissions and CWF Assistance Request as a result of a phone call, inquiry or correspondence received to ensure debtor information is accurate. The Benefits Coordination and Recovery Center (BCRC) must respond to all ECRS Inquiry and Assistance Requests for all contractors. This control objective pertains to the CRC and the BCRC. G – Control Number Control Objective – Medicare Secondary Payer (MSP) G.4 Contractors identify and track all incoming correspondence to ensure timely acknowledgement, response, and priority compliance with the Statement of Work (SOW) for MACs and other Medicare Contractors. All correspondence includes written inquiries, including letters, faxes, telephone inquiries, e-mails and any other forms of communication to support and complete a correspondence/inquiry action, shall be handled consistently for accuracy, professionalism and timeliness. These tracking mechanisms should include the ability to track ECRS submissions when awaiting response/status from the BCRC, or further actions such as claims adjustments after the BCRC has completed their investigation. This control objective pertains to MACs, BCRC, and CRC Contractors. G.5 Contractors shall have quality assurance measures in place to ensure the accuracy of the implementation of any CMS directive or any required work process/deliverable expressed in the SOW. Contractors shall also provide evidence that the results from quality assurance checks are documented to identify errors and that training venues are implemented to prevent the reoccurrence of these errors. This control objective pertains to MACs, BCRC, and CRC Contractors. End Section 50.7 – G Controls – Medicare Secondary Payer (MSP): Back to Table of Contents