100-05 Medicare Secondary Payer Manual: Chapter 3 Crosswalk

Medicare Secondary Payer (MSP) Manual
Chapter 3 - MSP Provider Billing Requirements
Crosswalk
New
Chap
New
Section
Int.
Pub. 13
Carrier
Pub. 14
HO
Pub. 10
HHA
Pub. 11
SNF
Pub. 12
PMs 	Description
3 	10 	A3-3491.14 	B3-3328.15 	HO-263.14 	HHA-253.13 	SNF-336.14 	General
3 	10.1 	Definitions of Provider of Service,
Health Care Provider, and Supplier of
Services
3 	10.2 	A3-3491.7
A3-3490.11
A3-3497.8
IM3497.8
HO-263.8 	HHA-252.14
HO-264.14
HO-263.8
HO-264.14
HHA-253.8
SNF-336.8
SNF-335.14
Limitation on Right to Charge a
Beneficiary
3 	10.2.1 	A3-3328.24 	Right of Physician or Supplier to
Charge Beneficiary
3 	10.3 	A3-3682
A3-3682.3
HO-264.9 	HHA-252.9
HO-469
HO-472
HHA-494
SNF-335.9
SNF-569
Situations in Which MSP Billing
Applies
3 	10.4 	A3-3489.2C 	HO-262.4
HO-262.10
HHA-248.2
HHA-251.4
SNF-332.4
SNF-334.2
Provider Responsibility When a Request
is Received From an Insurance
Company or Attorney
3 	10.5 	A3-3489.2D
IM3497.9
B3-3328.24C 	HO-262.4
HO-262.10
HO-289.24
HO-484.7
HHA-250.23
HHA-251.4
HHA-248.2
SNF-332.4
SNF-334.2
Provider Responsibility When Duplicate
Payments Are Received

New
Chap
New
Section
Int.
Pub. 13
Carrier
Pub. 14
HO
Pub. 10
HHA
Pub. 11
SNF
Pub. 12
PMs 	Description
3 	10.6 	HO-263.15 	HHA-252.15
HO-264.15
SNF-335.15
SNF-336.15
Incorrect GHP Primary Payments
3 	10.7 	A3-3418.29 	HO-264.3 	HHA-252.3 	SNF-335.3 	Retroactive Application
3 	10.8 	Medicare Health Maintenance
Organization (HMO) Contracts
3 	20 	A3-3490.12
A3-3491.4
A3-3418.4
A3-3489.2
A3-3492D
HO-262.4 	HHA-251.4
HO-262.10
HO-248.2
HO-263.5
HO-264.7
HO-300
HO-301
HHA-252.7
HHA-253.5
HHA-341
SNF-332.4
SNF-334.2
SNF-401
SNF-335.7
SNF-336.5
SNF-337
A-01-116
A-02-021
A-03-031
Obtain Information From Patient or
Representative at Admission or Start of
Care
3 	20.1 	A-02-021 	General Policy
3 	20.2 	HO-301.1 	Verification of Medicare Secondary
Payer (MSP) Online Data and Use of
Admission Questions
3 	20.2.1 	HO-301.2 	Admission Questions to Ask Medicare
Beneficiaries
3 	20.2.2 	HO-301.3 	Documentation to Support the
Admission Process
3 	30 	Provider Billing
(Section heading only)

New
Chap
New
Section
Int.
Pub. 13
Carrier
Pub. 14
HO
Pub. 10
HHA
Pub. 11
SNF
Pub. 12
PMs 	Description
3 	30.1 	A3-3491
A3-3491.6
A3-3491.6B
A3-3490
A3-3490.12B1
A3-3490.12B2
HO-262.4 	HHA-250.11
HO-263.1
HO-263.7
HO-264
HO-264.9
HO-289.11
HHA-251.4
HHA-252
HHA-252.9
HHA-253.1
HHA-253.7
SNF-327
SNF-332.4
SNF-335
SNF-335.9
SNF-336.1
SNF-336.7
Health Care Provider Billing Where
Services Are Covered by a GHP
3 	30.2 	A3-3489.2B 	HO-262.4 	HHA-251.4 	SNF-332.4 	Provider Billing Where Services Are
Accident Related
3 	30.2.1 	A3-3489
A3-3408.1B
HO-262.8 	HHA-248
HO-262.10
HO-262.14
HO-289.12
HHA-248.2
HHA-248.6
HHA-250.12
SNF-327.1
SNF-334
SNF-334.2
SNF-334.8
Health Care Provider Bills Automobile
Medical or No-Fault Insurer First
3 	30.2.1.1 	A3-3682.5A
A3-3689.2
HO-262.11 	HHA-248.3
HO-289.14
HO-262.10
HHA-248.2
HHA-250.14
SNF-329
SNF-334
SNF-334.2
No-Fault Insurance Does Not Pay
3 	30.2.1.2 	A3-3489.2B3 	HO-289.5
HO-289.14
HO-262.10
HHA-250.14
HHA-250.5
HHA-248.2
SNF-329
SNF-325.5
SNF-334.2
Liability Claim Also Involved
3 	30.2.1.3 	A3-3489.2B4 	HO-262.10 	HHA-248.2 	SNF-334.2 	No-fault Payment is Reduced Because
Proper Claim Not Filed
3 	30.2.2 	A3-3408.1A
A3-3408.2
A3-3408.4
HO-289.12 	HHA-250.12
HO-289.13
HO-289.14
HHA-250.13
HHA-250.14
SNF-327.1
SNF-327.2
SNF-329
Responsibility of Provider Where
Benefits May Be Payable Under
Workers' Compensation
3 	30.2.3 	A3-3408.3 	HO-289.14 	HHA-250.14
HO-289.18 	HHA-250.18
SNF-329.3
SNF-329
Responsibility of Provider Where
Benefits May be Payable Under the
Federal Black Lung (BL) Program

New
Chap
New
Section
Int.
Pub. 13
Carrier
Pub. 14
HO
Pub. 10
HHA
Pub. 11
SNF
Pub. 12
PMs 	Description
3 	30.3 	A3-3492.E
A3-3408
SNF-337 	Provider Billing Medicare for
Secondary Benefits
3 	30.4 	AB-03-011 	Instructions to Providers On How to
Submit Claims to a Medicare
Intermediary When There Are Multiple
Primary Payers
3 	30.5 	AB-03-111 	Instructions to Physicians and Suppliers
On How to Submit Claims to a
Medicare Carrier When There Are
Multiple Primary Payers
3 	40 	A3-3682 	HO-264.9
HO-469
HO-471
HO-472
HO-475
HO-470
HHA-494
HHA-252.9
HHA-495
HHA-496
HHA-497
SNF-335.9
SNF-569
SNF-571
SNF-572
SNF-570
Completing the Form CMS-1450 in
MSP Situations by Providers of Service
3 	40.1 	A3-3682.1
A3-3682.3
HO-472.1 	HHA-264.11
HO-472.3 	HHA-252.11
SNF-335.11 	Full Payment by the Primary Payer
(Section heading only)
3 	40.1.1 	Inpatient Services
3 	40.1.2 	A3-3682
A3-3682.4
HO-264.9 	HHA-494
HO-469
HO-472.2
HHA-252.9
SNF-335.9
SNF-569
Outpatient Bills, Part B Inpatient
Services, and HHA Bills
3 	40.2 	A3-3682.1B
IM3497.2
HO-263.11 	HHA-253.11 	SNF-336.11
HHA-264.10
HHA-252.10
SNF-335.10
Partial Payment by Primary Payer

New
Chap
New
Section
Int.
Pub. 13
Carrier
Pub. 14
HO
Pub. 10
HHA
Pub. 11
SNF
Pub. 12
PMs 	Description
3 	40.2.1 	A3-3682.1B 	HO-472.3 	Partial Payment by Primary Payer for
Inpatient Services, Outpatient Services,
Part B Inpatient Services, and HHA
Bills
3 	40.2.2 	A3-3682.2B
A3-3682.2B3
A3-3682.1B5
A3-3682.3B5
A3-3682.4B3
A3-3682.5
A3-3685.A2
HO-264.9 	HHA-252.9
HO-472
HO-472.3
SNF-335.9 	Partial Payment by Primary Payer That
Applies to Medicare Covered Services
3 	40.3 	A3-3491.9D
A3-3682.5
HO-263.10 	HHA-253.10
HO-472.3
SNF-336.10 	Annotation of Claims Denied by GHP's,
Liability or No-Fault Insurers
3 	40.3.1 	A3-3682.5 	HO-289.21 	HHA-250.20 	SNF-330 	Annotation of Claims to Request
Conditional Payments
3 	50 	Summary of MSP Data Elements for
Form CMS-1450 (UB-92)
3 	60 	B3-4020.1 	Completing the Form CMS-1500 in
MSP Situations by Suppliers of Service