Step 1: Determine the Type of MSP Record that Needs Correction
To check Medicare’s records, you can use the provider self-service tools listed under “Identify the Proper Order of Payers for a Beneficiary’s Services”. The record will be either a GHP or a non-GHP record and this will determine how to make the correction.
- If the record that needs correction is a GHP MSP record, contact the BCRC. You can identify GHP records by the MSP VC assigned to the record (MSP VCs 12, 13 or 43).
Examples of corrections to GHP records include but are not limited to: the GHP terminated for reasons other than retirement, the beneficiary is not enrolled in an EGHP, the beneficiary (or spouse or family member) is not working.
Note: You do not need to contact the BCRC if Medicare is primary to the GHP because the beneficiary and/or spouse retired. You can submit a Medicare primary claim for services rendered and report the beneficiary’s retirement date on it with OC 18 and/or the spouse’s retirement date on it with OC 19. National Government Services Medicare submits the retirement date(s) to the BCRC so that they can correct the beneficiary’s open MSP record and processes your claim unless there is some other reason why we cannot.
- If the record that needs correction is a non-GHP record, contact the BCRC. You can identify non-GHP records by the MSP VC assigned to the record (MSP VCs 14, 15, 41, or 47).
Examples of corrections to non-GHP records include but are not limited to: the non-GHP terminated, the non-GHP benefits exhausted, the case settled, the accident never occurred.
Note: You do not need to contact the BCRC if Medicare is primary to the non-GHP because the beneficiary’s services are not related to the accident. You can submit a Medicare primary claim and report in the remarks field that the services are not related to the open MSP record (identify which record with the MSP VC 14, 15, 41 and/or 47). National Government Services Medicare processes your claim unless there is some other reason why we cannot.
Step 2: Contact the BCRC to Request they Correct a Beneficiary’s MSP Record
You will need to supply the beneficiary’s identifying information shown in Step 1 in set up a beneficiary's MSP record to the BCRC. They may require that you send them additional information so they can investigate the MSP situation and correct the beneficiary’s MSP record.
- You can reach the BCRC via phone, mail or fax. Refer to the CMS BCRC web page for contact information.
Additionally, you must follow CMS’ guidelines for correcting MSP records for a beneficiary in MLN Matters special edition article SE1416.
Step 3: Wait for the BCRC to Correct the Open Beneficiary MSP Record
You will continue to check for the MSP record to be corrected. To check Medicare’s records, you can use the provider self-service tools listed under Step 2 in Identify the Proper Order of Payers for a Beneficiary’s Services. If the BCRC does not correct the MSP record, you must follow up with them.
Once the open MSP record is corrected, you can submit your Medicare primary claim, if applicable. You must report additional explanatory uniform billing codes, when applicable, on the claim. This coding can be found in prevent an MSP rejection on a Medicare primary claim.
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