Get Medicare Secondary Payer (msp) General Inquiry Form - Wps
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How to fill out the Medicare Secondary Payer (MSP) General Inquiry Form - WPS online
The Medicare Secondary Payer (MSP) General Inquiry Form is essential for providers submitting general inquiries to the Medicare Payment Recovery department. This guide will help you navigate the form effectively and ensure all necessary information is included.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Read the instructions provided at the beginning of the form carefully to understand the purpose and limitations of the document.
- Fill in your provider or supplier name in the appropriate field. Ensure that the National Provider Identifier (NPI) is accurately provided next.
- Input your Provider Transaction Access Number (PTAN) and the last five digits of your Tax Identification Number (TIN). Double-check each entry for accuracy.
- Complete the contact details, including address, telephone number, city, state, and ZIP code.
- Enter the contact person's name who is handling this inquiry and then proceed to fill out the patient's details, including their name, Medicare number, and date of birth.
- Provide the date of service and the Internal Claim Number (ICN) to ensure your inquiry is associated with the correct case.
- Select the reason for your inquiry from the available options. This step is crucial for the processing of your request.
- Include the Check/Electronic Funds Transfer (EFT) number if applicable. It's important for tracking inquiries related to payments.
- Save any changes made to your form, ensuring that all entries are correct before finalizing.
- Once completed, download, print, or share the form as necessary. Follow the instructions for mailing the completed inquiry form to the relevant address based on the state involved.
Take the first step today and complete your Medicare Secondary Payer inquiry form online.
Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.
Fill Medicare Secondary Payer (MSP) General Inquiry Form - WPS
Use this form to submit general inquiries and requests to WPS GHA. Providers submit secondary payment claims to Medicare when another insurance makes a primary payment. - This form may be utilized for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. A Medicare Secondary Payer Inquiry form is available in the Medicare Secondary Payer forms section of the Palmetto GBA website. The following are inquiries and solutions related to Medicare Secondary Payer (MSP) claim processing. Use for timely filing denials, bundling disputes, provider reimbursement, and medical documentation required denials. General Written Inquiry Forms. General MSP questions and information.
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