Set Up a Beneficiary's MSP Record

Table of Contents

• Set Up a Beneficiary's MSP Record
• Step 1: Check for a MSP Record for the Beneficiary on the CWF.
• Step 2: Prepare and Submit a MSP or Conditional Claim for the Beneficiary’s Services.
• Step 3: Wait for Medicare to Contact the BCRC with the New MSP Information You Reported on the Claim.
• Step 4: Check the CWF for the Beneficiary’s New MSP Record.
• Step 5: Return Your MSP or Conditional Claim Once the Beneficiary’s New MSP Record is on the CWF.
• Related Content

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Set Up a Beneficiary's MSP Record

• Fact: During your MSP screening process with the beneficiary, you may learn of new MSP information for a beneficiary that Medicare is not aware of (there is no MSP record for the beneficiary on the CWF). For MSP and certain conditional claims to process, there must be a MSP record for the beneficiary on the CWF with insurance information that matches to the claim you will submit.

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Step 1: Check for a MSP Record for the Beneficiary on the CWF.

You can check to determine if there is an MSP record for the beneficiary on the CWF using the provider self-service tools listed under Step 2 of Identify the Proper Order of Payers for a Beneficiary's Services. The MSP record must have the same information as you will report on your MSP or conditional claim. This is known as a matching MSP record.

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Step 2: Prepare and Submit a MSP or Conditional Claim for the Beneficiary’s Services.

Follow the instructions in Prepare and Submit a MSP Claim or Prepare and Submit a MSP Conditional Claim. Code your claim accurately including all of the primary insurance information.

Upon receipt of your MSP or conditional claim, we also check to determine if there is a matching MSP record for the beneficiary on the CWF (as you did prior to claim submission). If there is, we process the claim. If there is not, we contact the BCRC with the MSP information from your claim so they can set up a new MSP record on the CWF.

The BCRC reviews and, if necessary, investigates the new MSP information. If appropriate, they set up a new MSP record for the beneficiary on the CWF.

Note: Providers should not contact the BCRC to request they set up new or correct existing MSP records. in addition to reporting such information on Medicare claims, when applicable providers may refer beneficiaries and other entities to the BCRC.

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Step 3: Wait for Medicare to Contact the BCRC with the New MSP Information You Reported on the Claim.

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Step 4: Check the CWF for the Beneficiary’s New MSP Record.

Check using provider self-service tools listed under Step 2 of Identify the Proper Order of Payers for a Beneficiary’s Services.

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Step 5: Return Your MSP or Conditional Claim Once the Beneficiary’s New MSP Record is on the CWF.

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Related Content

• CMS Benefits Coordination & Recovery Center (BCRC) contacts web page
• Identify the Proper Order of Payers for a Beneficiary’s Services
• Prevent an MSP Rejection on a Medicare Primary Claim

Revised 10/25/2023