Get Medicare Secondary Payer Claim Development (sca) Page 1 - Cms

When sending claims on to the secondary payers, the payer wants to see the total billed amount of the claim, the amount the primary insurance paid on the claim, and the reasons why the billed amount was not paid fully by the primary payer.

The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the remaining costs. If your group health plan or retiree coverage is the secondary payer, you may need to enroll in Medicare Part B before they'll pay.

Medicare may be the secondary payer when: a person has a GHP through their own or a spouse's employment, and the employer has more than 20 employees. a person is disabled and covered by a GHP through an employer with more than 100 employees.

Medicare Secondary Payer (MSP) claims can be submitted electronically to Novitas Solutions via your billing service/clearinghouse, directly through a Secure File Transfer Protocol (SFTP) connection, or via Novitasphere portal's batch claim submission.

Currently, Medicare does not accept electronically filed claims when there is more than one payer primary to Medicare. Claims that involve more than one primary payer to Medicare must be submitted on the UB04 paper claim form, will all appropriate attachments.

Known as the Medicare Secondary Payer Questionnaire (MSPQ), this information is required to help determine if Medicare is a primary or secondary payer for the patient. ing to CMS, this new form is only a model of the questions to be asked and does not require use of the exact format.

When Medicare is the secondary payer, submit the claim first to the primary insurer. The primary insurer must process the claim in ance with the coverage provisions of its contract.