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| Avoiding Medicare Secondary Payer Overpayments National Government Services, the Jurisdiction B durable medical equipment Medicare administrative contractor (DME MAC) has observed a rise in overpayments involving Medicare as a secondary payer. Suppliers are encouraged to submit the initial claim with all pertinent information from the primary payer. This information is required even if the primary insurance does not pay. For paper claim submitters, suppliers should submit the primary explanation of benefits with the claim. This would include the glossary to explain the adjustments for the claim. Note:Suppliers who submit paper claims must have a valid Administrative Simplification Compliance Act (ASCA) Waiver on file. If a supplier is unsure if they have a valid ASCA waiver, they should contact the Jurisdiction B DME MAC Provider Contact Center to verify. Suppliers can call 1-866-590-6727, Monday - Friday 8:30 a.m.-5:30 p.m. ET. Suppliers submitting Medicare Secondary Payer (MSP) claims electronically must comply with all ANSI X12 837 Version 4010A1 implementation guide requirements. Submit all appropriate MSP information using the following ANSI 4010A1 loops and segments when reporting at a claim level.2000B.SBR Medicare Payer Information2300.CN1 Obligated to Accept Amount (CN102) - If there is a contractual obligation known, it MUST be submitted. Otherwise it will cause an overpayment on the claim.2320.SBR Primary Payer Information2320.CAS Primary Payer Claim Level Adjustments (Adjustment Reason Codes and Adjusted Amounts)2320.AMT Payer Amount Paid (AMT01=D)Approved Amount (AMT01=AAE)Amount Allowed (AMT01=B6)2320.DMG Subscriber Demographic Information2320.OI Primary Health Insurance Information2320.MOA Medicare Outpatient Adjudication Information - Would use if provided on the remittance from the primary.2330A.NM1 Insured or Subscriber Name2330A.N3 Insured or Subscriber Address2330A.N4 Insured or Subscriber City, State, Zip2330B.NM1 Other Primary Payer Information - NM109 must be the same as the 2430.SVD01 Submit all appropriate MSP information using the following ANSI 4010A1 loops and segments when reporting at a line level. 2400.CN1 Obligated to Accept Amount (CN102) - If there is a contractual obligation known, it MUST be submitted. Otherwise it will cause an overpayment on the claim.2400.AMT Approved Amount (AMT01=AAE)2430.SVD Service Line Information from Primary EOBPayer Amount Paid (SVD02)2430.CAS Primary Payer Line Level Adjustment Information (Adjustment Reason Codes and Adjusted Amounts)2430.DTP Date Claim Paid from Primary Payer InformationNote: MSP information/amounts should only be reported at either the claim or line level, not both. The adjustment/payments should be reported as they are indicated on the remittance from the primary insurance. A trend is occurring in that suppliers are not sending the Amount Obligated to Accept. This information is required in order to determine the Medicare secondary payment. If this field is not completed, Medicare's payment could be incorrect. If suppliers are unaware on where to report the above information, they should contact their software vendor. If an overpayment is received, suppliers should complete either the Medicare Secondary Payer Offset Request form or the Medicare Secondary Payer Voluntary Refund form. These forms can be found at www.NGSMedicare.com, click on Resources then Forms. For clarification on Medicare secondary payments, suppliers should contact the Provider Contact Center at the phone number listed above. |
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