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. |
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