Correct or Reopen a Claim Due to an MSP-Related Issue
Depending on the error, you can correct or reopen a MSP claim that has been submitted to Medicare for processing. If the claim is still in process, you will need to wait until it finalizes before any additional action can be taken.
Step 1: Identify the Finalized Status of the Claim and Take the Appropriate Action if Corrections/Changes are Needed
Review your remittance advice to determine the finalized status of the claim. If you do not understand the denial or none of the situations in Step 2 apply, please call the Provider Contact Center for assistance. Ensure that you have all the information required in order to obtain information/assistance from a representative.
Step 2: Take the Appropriate Action Depending on the Type of Denial/Correction that Needs to be Made
Claim Denied as Unprocessable or Returned (Message MA-130 on Your Povider Remittance Statement)
Determine what information is missing from the original claim submission and resubmit a correct claim. Refer to I need to prepare and submit a Medicare Secondary Payer claimfor additional information.
Claim Denied for Working Age, Disability, ESRD, or Veterans Administration, and Medicare should be Primary
If there is an open MSP file that needs to be terminated or deleted, you will first need to contact the BCRC. Refer to Correct a Beneficiary’s MSP recordfor additional information on this process. Once the file has been updated, you will be able to resubmit the claim to Medicare for processing.
If the MSP file is showing that it is now closed, resubmit the claim if the claim is still within the Medicare timely filing period (one calendar year from the date of service) or submit an appeal if the claim is beyond timely filing.
Claim Denied for Auto/No-Fault, Liability, Black Lung, Workers’ Compensation, Workers’ Compensation Set Aside, and Medicare Should be Primary
If there is an open MSP file that needs to be terminated or deleted, you will first need to contact the BCRC. Refer to Correct a Beneficiary's MSP Record for additional information on this process. Once the file has been updated, you will be able to resubmit the claim to Medicare for processing.
If the MSP file is showing that it is now closed, resubmit the claim if the claim is still within the Medicare timely filing period (one calendar year from the date of service) or submit an appeal if the claim is beyond timely filing.
If the claim is not accident related (auto/no-fault, workers’ compensation or liability), contact our Appeals Telephone Reopening Unit to request that the claim be reopened and reprocessed.
If there is a discrepancy, please call our Provider Contact Center for assistance.
MSP Claim Paid Incorrectly
Submit a written redetermination request and include all pertinent information.
Received Payment from Medicare and Another Payer as Primary
You will first need to determine which payer is the proper primary payer. Review Determine if Medicare is Primary or Secondary for a Beneficiary's Services for assistance and tips.
If Medicare is the proper secondary payer but paid as primary, then Medicare must be refunded. You will need to refund the difference between the amount Medicare actually paid and the amount Medicare should have paid (if any). The MSP regulations at 42 CFR 489.20 require that you repay Medicare within 60 days from the date you receive a payment from another payer (primary to Medicare) for the same service for which Medicare paid.
If you were the one who discovered the overpayment, use the Medicare Secondary Payer Part B Carrier Voluntary Refund Form and attach a check, or complete the Medicare Part B MSP Overpayment Request Form and attach a copy of the primary explanation of benefits.
If Medicare sent you a demand letter, follow the instructions within the demand letter. Please note: if you are on automatic recoupments for all and future, no action is necessary for repayment.
