Submitting Claims to Medicare When There Is an Accident Medicare Secondary Payer Record on the Common Working File
If there are accident diagnosis codes on the current claim (claim is for a current accident) and it has been verified during the MSP screening process that there are no primary insurers for the current accident (med-pay, no-fault, workers compensation and/or liability insurance) and that the services are not related to the active MSP XX accident record (where XX = 14, 15, or 47 as present on CWF), then submit a Medicare primary claim. In the Remarks field, indicate, “Services not related to active MSP XX accident record” (where XX = 14, 15, or 47 as present on CWF). In addition, report occurrence code 05 with the date of the current accident on the claim, and in the Remarks field explain why there is no other insurer liable. Occurrence code 05 identifies the claim as Medicare primary and acknowledges the screening process was performed.
Medicare Secondary Payer (MSP)
Billing and Medicare Secondary Payer Use this flow chart to determine if Medicare is secondary and for instructions on how to submit an MSP claim to Medicare, depending on the type of primary insurance involved such as working aged, disability, no-fault liability, worker’s compensation, black lung, veterans administration, and
Medicare Secondary Payer Questionnaire Test
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