Clues for Identifying MSP Calls



Clues for Identifying MSP Calls

|What Should I Look for? |

| |

|MSP calls come in many shapes and colors. The following guidelines will help you handle most MSP calls. However, always use your judgment when applying |

|these guidelines. |

| |

|Follow these steps to identify MSP calls: |

| |

|Listen and look for clues |

|Ask probing questions, if necessary |

|Decide if it is an MSP call. |

|Clues in a Letter, Form, or Bill |

|Listen for These Clues |Caller received a letter asking about an accident. |

| |Caller received a letter asking about other insurance. |

| |Caller received a letter asking for a retirement date. |

|Ask These Questions |Can you describe the letter/form/bill you are calling about? |

| |Does it have a title? |

| |Does it have a letterhead with return address and phone number? |

| |What department is it from? Who signed it? |

| |What does it say? |

| |Is there a date of service/provider or name/claim number? |

| |Does the letter/form/bill specify a claim? |

|Decide Using These Guidelines |It is an MSP call if the document the caller received is from the COB contractor. There are |

| |various Coordination of Benefits (COB) contractor issued letters. COB contractor letters all|

| |have a green colored COB logo in the upper right corner. |

| | |

| |These calls should be directed to the COB contractor. CSRs who handle MSP calls should |

| |direct these calls to the COB contractor. If there is an MSP department or MSP specialist in|

| |your center, transfer the call to them. They should direct the call to the COB contractor. |

| |If the call cannot be transferred, tell the caller to call 1-800-999-1118. |

| |If the document describes a particular claim (e.g., MSN/EOMB), ask the caller to specify the |

| |claim(s) and look up the beneficiary's record. |

|Clues Related to a |

|Specific Claim |

|Listen for These Clues |The provider has referred the caller to Medicare because the claim has a denial message |

| |related to MSP. |

| |The provider has told the beneficiary that insurance is not paying his or her bills because |

| |Medicare is primary. |

| |Caller uses the words “primary” or “secondary" in describing their claim. |

| |The beneficiary's record indicates other insurance that is primary to Medicare. |

| |The beneficiary's record indicates a denial message related to MSP. |

| |A beneficiary calls to report that they have retired or they are now working. |

| |A beneficiary calls to report a car accident or slip and fall type of accident. |

| |A beneficiary calls to report a work injury. |

| |A beneficiary calls to report a check made out to the beneficiary and Medicare. |

| |A beneficiary calls to report any type of settlement. |

| |A beneficiary calls to report an illness or injury caused by a defective product. |

|Ask These Questions |What is the number on your Medicare card? |

| | |

| |What provider and date of service are you calling about? (Look up the claim in the |

| |beneficiary's record.) |

| | |

| |If aged: |

| | |

| |Do you have insurance coverage through your current employer? |

|Ask These Questions (continued) |Are you employed? |

| |Is your spouse employed? |

| |What was your retirement date or last date of employment? |

| | |

| | |

| | |

| |If disability: |

| | |

| |Do you have insurance coverage through your current employer? |

| |Are you employed? |

| |What was your retirement date or last date of employment? |

| |Is a family member employed? |

| | |

| |If ESRD: |

| | |

| |Do you have insurance coverage through an employer? |

| | |

| |If Workers’ Compensation: |

| | |

| |Were you injured on the job? |

| |Did you receive a settlement? |

| | |

| |If no-fault/liability: |

| | |

| |Were you hurt in an accident? |

| |Did you receive a settlement? |

| | |

| |If liability, were you injured by a defective product? |

| | |

| |If no-fault/Workers’ Compensation, have benefits been exhausted for this injury? |

| |Note: If the caller does not know the answers to these questions, ask if someone is |

| |available to help. If no one is available, ask the beneficiary to call back later when he or|

| |she has the information or someone who can help is nearby. |

|Decide Using These Guidelines |It may be an MSP call if the caller is calling regarding the following types of insurance: |

| |Group Health Plan |

| |Federal Black Lung |

| |Workers’ Compensation |

| |No-Fault Insurance |

| |Liability |

| |COBRA (if the beneficiary has Medicare due to ESRD, COBRA may be primary) |

| |Employer Retiree Plan (if the caller has ESRD) |

| | |

|Decide Using These Guidelines (continued) |This is not an MSP call if the caller is calling regarding the following types of insurance: |

| |Medigap |

| |Complementary or supplemental insurance |

| |Medicaid |

| |TRICARE |

| |Medicare exclusions such as VA, services for individuals who are incarcerated, or services |

| |furnished outside the United States. |

| | |

| |It is an MSP call if the specified claim includes a denial message that reads/ or is similar |

| |to the following: |

| |Our records show that Medicare is your secondary payer. This claim must be sent to your |

| |primary insurer first. |

| | |

| |Claim denied because this care may be covered by another payer per coordination of benefits. |

| |Our records show that an automobile medical, liability, or no-fault insurance plan is primary|

| |for these services. |

| |Claim denied because medical services related to this injury are the liability of the |

| |no-fault carrier. |

| |This claim is denied because this/these service(s) may be covered by Workers’ Compensation. |

| |Ask your provider to submit a claim to the state Workers’ Compensation agency. |

| |No payment was made because your primary insurer’s payment satisfied the provider’s bill. |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download