CMS Pub. 100-05, ch. 5, § 10

Initial Medicare Secondary Payer (MSP) Development Activities by the MSP Contractor

The MSP Contractor responsible for coordination of benefits (formerly known as the Benefits

Coordination & Recovery Center or the Coordination of Benefits Contractor and hereafter termed the

“MSP contractor”) consolidates activities that support the collection, management, and reporting of all

other health insurance coverage of Medicare beneficiaries, as well as all insurance coverage obligated

to pay primary to Medicare. The MSP Contractor assumed responsibility for virtually all initial MSP

development activities formerly performed by A/B MACs and DME MACs. The MSP Contractor is

charged with ensuring the accuracy and timeliness of updates to the Common Working File (CWF)

MSP auxiliary file. The MSP Contractor does not process claims, nor claims specific inquiries

(telephone or written). The MSP Contractor is responsible for determining the existence or validity of

MSP for Medicare beneficiaries. The MSP Contractor handles all MSP related inquiries, including

those seeking general MSP information, but not those related to specific claims or recoveries. These

inquiries (verbal and written) can come from any source, including but not limited to beneficiaries,

attorneys/beneficiary representatives, employers, insurers, providers, suppliers and A/B MACs and

DME MACs and the MSP contractor.

The MSP Contractor is primarily an information gathering entity. The MSP Contractor is dependent

upon various sources to collect this information. With limited exceptions (e.g., claim clarification with

provider to avoid returning the claim to the provider (RTP)), A/B MACs and DME MACs are no

longer responsible for initiating MSP development and making MSP determinations. Following CMS’

correspondence guidelines (found in Pub. 100-09 chapter 6); the A/B MACs and DME MACs shall

forward all information that they receive that might have MSP implications to the MSP Contractor.

This requirement includes filling out all fields in the Electronic Correspondence Referral System

(ECRS) Web where the information is available. If the A/B MACs and DME MACs do not have the

information, and it is not a required field, the A/B MACs and DME MACs shall leave the field blank.

Only with this timely and accurate information can the MSP Contractor evaluate all relevant

information to make the correct MSP determination and appropriately update CWF for proper claims

adjudication. Once the MSP record has been established on CWF by the MSP Contractor, the MSP

Contractor shall be responsible for all MSP activities related to the identification and recovery of

MSP-related debts.

All A/B Medicare Administrative Contractors (MACs) (Part A), A/B MACs (Part B), or A/B MACs

(Part HHH) (collectively referred to as A/B MACs) and Durable Medical Equipment MACs (DME

MACs) shall contact their consortia representative for inquires related to specific workload activities.

All A/B MACs and DME MACs shall provide the MSP Contractor, through CMS with a list of names,

private phone numbers, and fax numbers of each A/B MAC and DME MAC primary and backup MSP

contact on a quarterly basis as instructed in CMS TDL-140383 so the MSP Contractor may follow-up

with the A/B MACs and DME MACs as needed.