Awareness : OBC Tips

Verifying Medicare Secondary Payer Data


Providers should not submit a claim to Medicare until they have properly determined whether or not Medicare is the primary payer. Medicare providers are required to gather accurate MSP data, by asking Medicare beneficiaries, or their representatives, for information such as group health coverage through employment or non-group health coverage resulting from an injury or illness. The CMS MSP  admission questionnaire may be used as a guide to help identify all responsible payers, upon each inpatient and outpatient admission.
Condition code 08 may only be used when a beneficiary refuses to provide information concerning other insurance coverage. The condition code 08 will trigger the coordination of benefits contractor (COBC) to develop for insurance information with the beneficiary, and the claim will reject as MSP.