Medicare Top Ten Denials and action - Medicare secondary payer

Action - Denied as Medicare Secondary Payer (MSP)




MRA reason code PR-22: This care may be covered by another payer per coordination of benefits.


Resolution

· Patient screening is an excellent way for providers to obtain valuable information necessary for proper claims submission. Claim rejections and/or denials will occur if complete patient insurance information is not obtained. Providers are required to file claims based on information obtained from the patient prior to submitting the claim.

· Providers should verify MSP information prior to submitting the claim; this will help reduce the number of incorrect denials. Providers may also call the IVR to verify MSP information.
· Paper billers – When Medicare is the secondary insurance, it is important to complete
Items 4, 6, 7, 10 and 11–11d on the CMS-1500 Claim Form as well as attach a copy of the primary
insurance remittance notice for Medicare to process the claim accurately and timely.
· Electronic billers – When Medicare is the secondary insurance, it is important to
complete the required MSP fields for the claim to be processed accurately and timely

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