US · guidance
CMS Pub. 100-05, ch. 5, § 30.5.1
No-Fault Insurer Denies That It Is the Primary Payer
Denial by an insurer on the basis that Medicare is the primary payer may be a forerunner
of similar action on multiple claims. Advise the MSP Contractor of this circumstance via
ECRS if the CARC shows a valid reason why the claim was denied; e.g., benefits were
exhausted or other reasons as described in the IOM or CMS CRs such as CMS CRs
6426 and 6427 including subsequent CRs. The MSP Contractor is responsible for any
needed follow-up action with the no-fault insurer. See sections 40.6 and 40.6.1 for
reasons why the NGHP insurer may deny the claim and that Medicare may make a
conditional payment.
History
(Rev. 11550; Issued: 08 -12-22; Effective: 10 -13-22; Implementation:10 -13-22)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
562cd9e1117af48bb8b66362c5d0b88c1ddb41a2aabaa91b724539dd436d20d6
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