CMS Pub. 100-05, ch. 5, § 40.8.12

Payer

(Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22)

A/B MACs (Part A) submit data concerning the patient's utilization days, deductible,

coinsurance amounts and MSP payment amounts to CWF. Utilization days used and

deductible and coinsurance amounts satisfied are determined in the MSP payment

modules after calculation of the Medicare payment amount.

The "Utilization Days" field of the CWF Record contains the days to be charged to the

beneficiary's Medicare utilization record as determined above.

The "Value Code" fields of the CWF Record identify the coinsurance and amount

charged the beneficiary as well as an MSP type of primary payer and the primary payer

amount.

Value code 44 and the amount are entered on the CWF Record in the appropriate fields

(see CWF Documentation). Value code 44 indicates the amount the provider is obligated

to accept as payment in full from the primary payer and this amount is greater than the

amount paid by the primary payer for Medicare covered services entered by the provider

in the identifying primary payer value code.

For the PS&R, the A/B MAC (Part A) records the primary payment amount

minus any deductible or coinsurance amounts.