MSPRC

There are any number of situations where Medicare is the primary payer. If you have another insurance policy or plan or other insurance is available that may pay your claims (such as automobile insurance), and you are not sure who the primary payers is, please call the Coordination of Benefits Contractor to determine primary and secondary billing issues. The number to call is 800-999-1118.

Medicare is the secondary payer when a person has other insurance that is required, by law, to pay its benefits before Medicare. Medicare may be secondary to group employer health plans, no-fault insurance, liability insurance and workers compensation. If you have another insurance policy or plan or other insurance is available that may pay your claims and you are not sure who the primary payer is, please call the Coordination of Benefits Contractor to determine primary and secondary billing issues. The number to call is 800-999-1118.

The MSPRC is the new national MSP Recovery Contractor as of October 2, 2006. All the functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries are the responsibility of the MSPRC. The MSPRC has taken over new MSP recovery cases and most existing cases, with some exceptions (e.g. provider debt).

Contact the MSPRC for information on any of the following:♦ to obtain conditional payment amounts; ♦ to obtain Medicare's final recovery claim amount; ♦ to ask questions regarding MSP recovery demand letters; ♦ to ask questions with respect to a "Notice of Intent to Refer Debt to the Department of Treasury" letter; ♦ to ask questions regarding repaying Medicare.

Recover Medicare Secondary Payer (MSP) Debts: ♦ Identify and recover MSP debts timely, accurately, and reliably. ♦ Identify mistaken or conditional MSP payments for recovery. ♦ Determine and provide conditional payment amounts. ♦ Enhance Customer Service. ♦ Manage relationships with debtors. ♦ Continually improve and enhance the service we provide to our customers. ♦ Operational Excellence: Promote the consolidation and the enhancement of MSP recovery operations.

The Centers for Medicare & Medicaid Services (CMS) consolidated all of the functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries (with the exception of physician, provider and supplier overpayments) into one MSP recovery contract. The contract for the new national MSP Recovery Contractor (MSPRC) was implemented on October 2, 2006. The MSPRC has taken over new MSP recovery claims and most existing claims. However, a very limited number of existing MSP recovery claims will remain the responsibility of the claims processing contractors. The MSPRC should be the first point of contact regarding recovery claims. If needed, the MSPRC will redirect your inquiry if the recovery case is being handled by another Medicare contractor.

Since insurance information can frequently change, it needs to be verified each time you receive health services. Medicare wants to ensure that your claims are submitted to the insurer that is responsible for paying first.

The health care provider may bill the wrong insurance company. This may lead to claims being paid incorrectly.

The recovery of provider, physician or other supplier MSP recovery claims will continue to be the responsibility of the contractor that processed the underlying Medicare claim.  The claims processing contractors will issue MSP recovery demand letters to providers, physician, and other suppliers. You should respond to the entity that issues the recovery demand letter to you.

The COBC is responsible for all initial Medicare Secondary Payer (MSP) development activities. All MSP claims investigations are initiated from and researched by the COB Contractor. The COB Contractor provides customer service to all callers from any source (beneficiary, provider, etc). The toll-free COB Call Center telephone number is 800-999-1118; hours of operation are 8 AM-8PM, Monday - Friday EST.

It is likely that Medicare’s records reflect that you were involved in an accident and that there is other insurance is available to pay your claims. If you feel Medicare should pay the claim(s), please call the Medicare Secondary Payer Recovery Contractor at 1-866-677-7220.

Your claims will not be paid until this information is received.

Your organization either has sole liability or shares liability for a debt to the Medicare program. The repayment claim arose because Medicare mistakenly made primary payments for services furnished to Medicare beneficiaries that should have been the primary payment responsibility of a Group Health Plan that you sponsor or to which you contribute.

There are three criteria to be eligible for Medicare: someone who is 65 years or older, someone who has End-Stage Renal Disease, or someone who is entitled to Medicare because of a disability. If none of these conditions apply to anyone in your company, it is possible that the spouse or family member of one of your workers is Medicare eligible.

This term applies to Medicare beneficiaries who are 65 or older, actively employed and have their own Group Health insurance, or are covered under their spouse’s insurance through their spouse’s current employment.

The working aged provision applies to all employers that have 20 or more employees. The employer must offer older employees the same health insurance benefits that is offered to their younger employees and cannot take into account the fact that Medicare covers the employee or their spouse.

Medicare was originally created, in 1965 and signed into law in 1966,  to provide health insurance coverage to those in our society who did not have access to such coverage once they stopped working, namely the elderly and the disabled. It has since been expanded to cover end stage renal disease, workers compensation, and to include prescription drug coverage.  

Recovery work performed on provider, physician or other supplier MSP claims will continue to be the responsibility of hte contractor that processed the original Medicare claim. Consequently, providers, physicians and other suppliers should not see any changes in existing processes for recovering debts.