100-05 Medicare Secondary Payer Manual: Chapter 5 Crosswalk
us-cms-medicare-manuals-pub-100-05-msp105c05crosswalk100-05 Medicare Secondary Payer Manual: Chapter 5 CrosswalkGuidance
Medicare Secondary Payer (MSP) Manual Chapter 5 - Contractor Prepayment Processing Requirements Crosswalk New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 10 AB-00-107 Coordination With the Coordination of Benefits Contractor (COBC) 5 10.1 AB-00-107 FI and Carrier MSP Auxiliary File Update Responsibility AB-02-022 AB-02-107 5 10.2 AB-00-107 COBC Electronic Correspondence Referral System (ECRS) 5 10.2.1 AB-00-107 ECRS Functional Description 5 10.2.2 AB-00-107 Technical Overview - Impact on FI/Carrier Data Centers 5 10.2.2.1 AB-00-107 CWF Assistance Request - Data Elements and Definitions 5 10.2.2.2 AB-00-107 MSP Inquiry Information - Data Elements and Definitions B-01-033 5 10.3 AB-00-107 Providing Written Documents to the COBC 5 10.4 AB-00-107 FI and Carrier Record Retention 5 10.5 AB-00-107 Notification to FI or Carrier of MSP Auxiliary File Updates 5 10.6 AB-00-107 Referring Calls to the COBC 5 10.7 AB-00-107 Changes in FI and Carrier Initial MSP Development Activities B-01-033
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 10.8 AB-00-107 Additional Activities Arranged by Non-GHP MSP Type AB-02-022 5 10.8.1 AB-00-107 No-Fault Development 5 10.8.2 AB-00-107 Workers' Compensation (WC) Development 5 10.8.3 AB-00-107 Liability Development 5 10.9 AB-00-107 COBC Numbers 5 20 A3-3489.3 A3-3492.J B3-3328.6 B3-4301 B3-3338.2 SNF-337 Sources That May Identify Other Insurance Coverage 5 20.1 A3-3418.5 A3-3489 A3-3489.3A B3-3340.4 B3-4305 B3-3338.2A B3-4301 HO-262.8 HHA-248 SNF-334 AB-00-107 Identification of Liability and No-Fault Situations 5 20.2 A3-3409 A3-3409.1 A3-3409.2 B3-3330.1 B3-3330.2 B3-4305 Identify Claims with Possible WC Coverage 5 20.3 B3-4304 Medicare Claims Where Veterans' Affairs (VA) Liability May Be Involved 5 20.3.1 B3-4304.1 B3-4304.2 VA Payment Safeguards 5 30 A3-3686 Develop Claims for Medicare Secondary Benefits 5 30.1 A3-3686.1 Further Development Is Not Necessary 5 30.2 Further Development Is Required
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 30.3 A3-3491 A3-3686 A3-3492.I B3-4302 B3-3328.6 HO-253 HHA-253 SNF-336 GHP May Be Primary to Medicare 5 30.3.1 B3-4301.1D B-01-033 Limits on Development 5 30.3.2 B3-4303 Develop ESRD Claims Where Basis for Medicare Entitlement Changes 5 30.4 A3-3409.3 A3-3409.9 B3-3330.3 HHA-250.19 SNF-329.7 Workers' Compensation Responses 5 30.4.1 B3-3330.4 Patient Receives Concurrent Services Which Are Not Work-Related 5 30.5 A3-3489.3B No-Fault Responses 5 30.5.1 B3-3338.4 No-fault Insurer Denies That It Is the Primary Payer 5 30.5.2 A3-3489.4 B3-3338.5 HO-262.12 HHA-248.4 SNF-334.4 No-Fault Insurance Does Not Pay All Charges Because of a Deductible or Coinsurance Provision in Policy 5 30.5.3 A3-3489.5 B3-3338.6 HO-262.12 HO-262.13 HHA-248.4 HHA-248.5 SNF-334.4 SNF-334.5 State Law or Contract Provides That No-Fault Insurance Is Secondary to Other Insurance 5 30.6 A3-3489.6 B3-3338.7 B3-3340.7 Liability Claim Is Filed and There is Also Coverage Under Automobile or Non- Automobile Medical or No-Fault Insurance 5 30.7 A3-3686 B3-3328.7 Beneficiary Refuses to Provide Requested Information 5 30.8 A3-3491.5 A3-3490.3 HO-263.3 HHA-252.7 HO-264.7 HHA-253.6 SNF-335.7 SNF-336.6 Audit Trail of Primary Coverage 5 40 FI and Carrier Claim Processing Rules 5 40.1 A3-3490.3 IM3491 B3-3328.7 Claim Indicates Medicare is the Primary Pay
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 40.1.1 A3-3409.4 B3-3330.5 Facts Indicate Reasonable Likelihood of Workers' Compensation Coverage (Other Than Federal Black Lung Benefits) 5 40.1.1.1 A3-3409.5 B3-3330.6A The Beneficiary Is on the Black Lung Entitlement Rolls 5 40.1.2 A3-3490.16A A3-3491.17A B3-3329.4A HO-263.17 HO-264.17 HHA-253.16 HHA-253.17 SNF-335.17 SNF-336.17 Services by Outside Sources Not Covered 5 40.1.2.1 A3-3490.16B A3-3491.17B B3-3329.4B HO-263.17 HO-264.17 HHA-252.17 HHA-253.16 SNF-335.17 SNF-336.17 Exception 5 40.1.3 A3-3490.16C A3-3491.17C B3-3329.4 HO-263.17 HO-264.17 HHA-252.17 HHA-253.16 SNF-335.17 SNF-336.17 Notice to Beneficiary 5 40.2 A3-3490.16D A3-3491.17DC B3-3329.4D HO-264.17 HHA-252.17 SNF-335.17 Update CWF MSP Auxiliary File 5 40.2.1 B3-3338.2C.1 HO-263.17 HHA-253.16 SNF-336.17 Action if Payment Has Been Made Under No- Fault Insurance 5 40.3 B3-3328.7 Processing Part B Claims Involving GHPs 5 40.3.1 A3-3491.9 A3-3490.3D A3-3490.3F B3-3328.4 B3-3328.C1 B3-3328.5 HO-263.10 HHA-253.10 SNF-336.10 GHP Denies Payment for Primary Benefits 5 40.3.2 B3-3328.8 GHP Does Not Pay Because of Deductible or Coinsurance Provision 5 40.3.3 B3-3328.9 GHP Gives Medicare Beneficiary Choice of Using Preferred Provider 5 40.4 B3-3328.2 GHP Pays Primary 5 40.4.1 B3-3328.2 GHP Pays Charges in Full 5 40.4.2 B3-3328.3 GHP Pays Portion of Charges
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 40.4.3 A3-3490.13 B3-3328.16 GHP Pays Primary Benefits When Not Required 5 40.5 B3-3328.14 Primary Payer Is Bankrupt or Insolvent 5 40.5.1 B3-3328.14B Billing Beneficiaries During the Liquidation Process 5 40.5.2 B3-3328.14C When to Make a Medicare Secondary Payment 5 40.5.3 B3-3328.14D Amount of Secondary Payment 5 40.5.4 B3-3328.14E Time Limits for Filing Secondary Claims After Liquidation Process 5 40.6 A3-3490.3E A3-3682.5B A3-3682.5E A3-3682.5G Conditional Primary Medicare Benefits 5 40.6.1 A3-3407.6B A3-3682 B3-3338.3 B3-2370.6 Conditional Medicare Payment 5 40.6.2 A3-3690.3F A3-3489.8 A3-3682.5D A3-3682.5E A3-3682.5G B3-3338.3 HO-262.14 HHA-248.6 SNF-334.6 When Primary Benefits and Conditional Primary Medicare Benefits Are Not Payable 5 40.6.3 B3-3328.C1 Conditional Primary Payment in Cases Involving a Denied Claim That Was Appealed 5 40.7 B3-4301.1 Carrier Processing Procedures for Medicare Secondary Claims 5 40.7.1 Crediting the Part B Deductible 5 40.7.2 B3-4301.1 B3-3328.20 Medicare Payment Calculation Methodology
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 40.7.3 B3-3328.20 Medicare Secondary Payment Calculation Methodology for Services Reimbursed on Reasonable Charge or Other Basis Under Part B 5 40.7.4 B3-3328.20B Effect of Medicare Limiting Charge on Medicare Secondary Payments 5 40.7.4.1 B3-3328.20C GHP Does Not Pay for Certain Services 5 40.7.4.2 B3-3328.20D Third Party Payment Includes Both Medicare Covered and Noncovered Services 5 40.7.5 B3-3328.21 Effect of Failure to File Proper Claim 5 40.7.6 B3-3328.23 Medicare Secondary Payment for Managed Care Organizations' (MCO) Copayments 5 40.7.7 B3-3328.25 Charging Expenses Against Annual Limit on Incurred Expenses for Services of Independently Practicing Physical Therapists 5 40.8 A3-3490.3 A3-3685.B A3-3685.C HO-475 Intermediary Processing Procedures for Medicare Secondary Claims 5 40.8.1 IM3497.2 IM3497.5 A3-3407B3 A3-3490.7 A3-3491.11 A3-3682 IM3497.5 A3-3685.A.1 HO-475 Medicare Secondary Payment Calculation Methodology When Proper Claim Has Been Filed
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 40.8.2 IM3497.5B A3-3685.A1 A3-3683 A3-3682.3B6 A3-3682.4B4 A3-3685.D HO-473 HHA-498 HO-475 SNF-573 Rule to Determine the Amount of Secondary Benefits 5 40.8.3 A3-3682.1B6 A3-3683 A3-3685.C HO-472.3 HHA-498 HO-473 HO-475 SNF-574 Application of the MSP Formula 5 40.8.4 A3-3682.2 PIP Reduction 5 40.8.5 A3-3682.2.A A3-3682.1C HO-472.3 MSP Part B Claims (Outpatient and Other Part B Services, Home Health Part B and Ancillary Services When Part A Benefits are Exhausted) 5 40.8.6 A3-3695.A HO-477 MSP Outpatient Claims Involving LAB Charges Paid by Fee Schedule 5 40.8.6.1 A3-3695.B Prorating Primary Payments 5 40.8.6.2 A3-3695.C Calculation of Deductible and Coinsurance 5 40.8.7 IM3497.5 IM3497.6 Calculating Medicare Secondary Payments When Proper Claim Has Not Been Filed With Third Party Payer 5 40.8.8 A3-3682.B3 A3-3682.1B A3-3685.A3 IM3497.6 IM3497.7 HO-472.3 HO-475 Determining Patient Utilization Days, Deductible, and Coinsurance Amounts 5 40.8.9 A3-3684 HO-474 SNF-574 Benefits Exhausted Situations When Medicare Is Secondary Payer for Reasonable Cost Providers
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 40.8.10 A3-3688 HO-476 SNF-575 Deductible and/or Coinsurance Rates Spanning Two Calendar Years 5 40.8.11 A3-3682.1A A3-3682.3A HO-472.3 Submit Data to CWF When Full Payment Made by Primary Payer 5 40.8.12 A3-3682.1A A3-3682.B7 A3-3682.1B7 A3-3682.2B5 HO-472.3 Submit Data to CWF When Partial Payment Made by Primary Payer 5 50 B3-4306 MSP Pay Modules to Calculate Medicare Secondary Payment Amount 5 50.1 B3-4306 Medicare Secondary Payer (MSP) Payment Modules (MSPPAY) for Carriers 5 50.1.1 A3-3697.B B3-4306.B Payment Calculation Processes for MSP Claims 5 50.1.2 B3-4306C MSPPAY "Driver" Module 5 50.1.3 B3-4306D Return Codes 5 50.1.4 B3-4306E Executing and Testing MSPPAY Software 5 50.1.5 B3-4306F Carrier MSPPAY Processing Requirements 5 50.1.6 B3-4306G Error Resolution 5 50.1.7 B3-4306.1 Payment Calculation for Physician/Supplier Claims (MSPPAYB Module) 5 50.1.8 B3-4306.2 Payment Calculation for Physician/Supplier Claims (MSPPAYBL) 5 50.2 A3-3697 Medicare Secondary Payer (MSP) Payment Modules (MSPPAY) For Intermediaries 5 50.2.1 A3-3697 Payment Calculation Processes for MSP Claims 5 50.2.2 A3-3697.C MSPPAY "Driver" Module
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 50.2.3 A3-3697.D Return Codes 5 50.2.4 A3-3697.E Installation 5 50.2.5 A3-3697.F Intermediary Processing Requirements 5 50.2.6 A3-3697.G Error Resolution 5 50.2.7 A3-3697.1 A3-3697.1A Payment Calculation for Inpatient Bills (MSPPAYAI Module) 5 50.2.8 A3-3697.2 Payment Calculation for Outpatient Claims (MSPPAYOL) 5 50.2.8.1 A-03-006 MSPPAY Update to Apportion Prospective Payment System (PPS) Outlier Amounts to All Service Lines with Potential Outlier Involvement 5 50.2.9 A3-3697.3 A3-3697.3B Payment Calculation for Outpatient Bills (MSPPAYAO Module) 5 50.3 AB-03-011 Multiple Primary Payer Amounts For a Single Service 5 60 A3-3899 B3-13450 MSP Reports 5 60.1 A3-3899.1 B3-13450.1 Monthly Intermediary Report (Form CMS- 1563) and Monthly Carrier Report (Form CMS-1564) on Medicare Secondary Payer Savings 5 60.1.1 A3-3899.2 A3-3899.3 A3-3899.4 B3-13450.2 B3-13450.3 B3-13450.4 Overview of Report 5 60.1.2 A3-3899.5 A3-3418.25 B3-13450.5 Savings Calculations 5 60.1.3 A3-3899.6 B3-13450.6 Recording Savings 5 60.1.3.1 A3-3899.7 B3-13450.7 Source of Savings
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 60.1.3.2 A3-3899.8 B3-13450.8 Type of Savings 5 60.1.3.2.1 A3-3899.8A B3-13450.8 Unpaid (Cost Avoided) MSP Claims 5 60.1.3.2.2 A3-3899.8 B3-13450 Full Recoveries 5 60.1.3.2.3 A3-3899.8 B3-13450 Partial Recoveries 5 60.1.3.2.4 A3-3899.8 B3-13450 Totals 5 60.1.3.2.5 A3-3899.8 B3-13450.8 Pending Claims/Cases 5 60.1.3.3 A3-3899.9 B3-13450.9 Electronic Submission 5 60.1.3.3.1 A3-3899.9 B3-13450.9 Data Entry of the Forms CMS-1563 and CMS- 1564 5 60.1.3.3.2 A3-3899.9 B3-13450.9 Edits for Forms CMS-1563 and CMS-1564 5 60.2 A3-3418.26 Liability Settlement Tracking Report 5 70 A3-3693 HO-480 Hospital Review Protocol for Medicare Secondary Payer 5 70.1 A3-3691.1 HO-480.1 HO-480.2 HO-480.4 Reviewing Hospital Files 5 70.1.1 A3-3693.2 HO-480.3 HO-480.6 Frequency of Reviews and Hospital Selection Criteria 5 70.1.2 A3-3693.3 HO-480.5 Methodology for Review of Admission and Bill Processing Procedures 5 70.2 A3-3693.4 HO-480.7 Selection of Bill Sample 5 70.3 A3-3693.5 HO-480.8 Methodology for Review of Hospital Billing Data 5 70.3.1 A3-3693.5C HO-480.5C Review of Form CMS-1450 5 70.3.1.1 A3-3693.5C1 General Review Requirements 5 70.3.1.2 A3-3693.5C2 Working Aged Bills
New Chap New Section Int. Pub. 13 Carrier Pub. 14 HO Pub. 10 HHA Pub. 11 SNF Pub. 12 PMs Subject 5 70.3.1.3 A3-3693.5C3 Accident Bills 5 70.3.1.4 A3-3693.5C4 Workers' Compensation Bills 5 70.3.1.5 A3-3693.5C5 ESRD Bills 5 70.3.1.6 A3-3693.5C6 Bills for Federal Government Programs 5 70.3.1.7 A3-3693.5C7 Disability Bills 5 70.3.2 A3-3693.5D Use of Systems Files for Review 5 70.3.3 A3-3693.6 HO-480.6 Review of Hospitals With Online Admissions Query 5 70.4 A3-3693.7 HO-480.7 Assessment of Hospital Review 5 70.5 A3-3693.8 Exhibits 5 70.5.1 Exhibit 1: Assessment of Medicare Secondary Payer Hospital Review 5 70.5.2 Exhibit 2: Survey of Bills Reviewed 5 70.5.3 Exhibit 3: Entrance Interview Checklist 5 70.5.4 Exhibit 4: Entrance Interview Checklist: Billing Procedures 5 Att 1 AB-03-081a Electronic Correspondence Referral System (ECRS) User Guide v6.0 5 Att 2 AB-03-081b Electronic Correspondence Referral System (ECRS) - Quick Reference Card
Continue your research in ChatGPT or Claude
Connect Omnilex to search the legal corpus from your AI assistant.