US · guidance
CMS Pub. 100-05, ch. 5, § 50.2.5
Part A Processing Requirements
The following processing requirements apply:
• The A/B MACs (Part A) and A/B MACs (HHH) processes all MSP inpatient
hospital, SNF, HHA bills through the MSPPAY software to determine MSP payment
amount, deductible, coinsurance, and savings.
• The A/B MACs (Part A) and A/B MACs (HHH) processes all MSP outpatient
bills through the MSPPAY software, at the line level, to determine MSP payment
amount, deductible, coinsurance, and savings.
• Bills processed by MSPPAY must be in ready-to-pay status, e.g., the amount
that Medicare would have paid as the primary payer, the type of MSP situation, the
amount of the primary insurer's payment, information regarding outstanding deductible
and coinsurance must be available to MSPPAY; and
• All data elements required by MSPPAY must be passed to it. Sections
50.2.7.A and 50.2.8.A list these data elements. The Medicare Secondary Payment
Technical manuals also contain additional information about them.
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
6fff65a90be725f8a1a454bf351be2223cdd4da867c367288f1bd75c9213adfc
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