CMS Pub. 100-05, ch. 5, § 60.1.3

For purposes of this manual, Medicare beneficiary identifier references both the Health

Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the

new Medicare card transition period and after for certain business areas that will continue to

use the HICN as part of their processes.

The A/B MACs and DME MACs control all claims from which MSP savings are extracted and

verifies all amounts recorded on the Forms CMS-1563 or CMS-1564 when requested. All

prepay and post pay MSP Savings must be uploaded in the CROWD/MDX system.

A. MSP Savings File

The A/B MACs and DME MACs retain specific key identifying information on each claim

counted as savings on the Forms CMS-1563 or CMS-1564. At a minimum, it records the

beneficiary's name, Medicare beneficiary identifier, type and dates of service, claim control

number, billed charges and savings amounts reported.

B. Savings Data from Non-Medicare Sources

If savings are recorded from data obtained from the A/B MACs and DME MACs "corporate

side" records or any other "outside" source, the A/B MACs and DME MACs extract the same

claims specific information noted above, i.e., verifies that Medicare covered services are

involved and that it is able to calculate "what Medicare would have paid." In addition, A/B

MACs and DME MACs must compare this data with the data contained in the MSP savings file

to ensure that savings have not previously been recorded for the same claims. If savings have not

previously been taken for the claim, the A/B MACs and DME MACs count them as savings on

the Forms CMS-1563 or CMS-1564 and enters them into the A/B MACs and DME MACs MSP

savings file.

C. Total Savings for Special Projects

The MSP Contractor, A/B MACs and DME MACs shall total each respective Special Project

Savings and place these totals under their respective special project columns in the Special

Project Savings Total in the CROWD Savings Report. A/B MACs and DME MACs and the

designated shared system shall apply the correct MSP cost avoided indicator that pertains to the

incoming claim, including subsequent adjustments, and apply the savings to the originating

contractor under the appropriate special project and MSP type in CROWD. Note, for savings

reporting purposes the term contractor is identified to mean the MSP Contractor or A/B MAC

and DME MAC number unless specified. The A/B MACs and DME MACs and designated

shared systems shall apply the appropriate MSP indicator that pertains to each service line on

the incoming claim. This includes applying the MSP savings to the originating contractor of the

MSP record under the appropriate special project and MSP type in CROWD at the line level for

cost avoided claims, full and partial recoveries, and total savings for prepay and post pay MSP.

If there are different MSP lines on the same claim, the service lines shall be counted under each

MSP type, by the originating contractor, for each service line in CROWD. For example, there

are three MSP occurrences on CWF. Occurrence 1 is an open working aged record created by

contractor 11101. Occurrence 2 is an open Workers’ Compensation Set Aside (WCMSA) record

created by contractor 11119. Occurrence 3 is a closed workers’ compensation record. A claim is

received for two services: one service is for a routine checkup and the second service is for the

workers’ compensation injury for which the beneficiary has a WCMSA . MSP savings related to

the routine physical would be applied to originating contractor 11101, special project 6010,

under the working aged column in the savings report. Savings related to the WCMSA would be

applied to originating contractor 11119, specia l project 7019, under the workers’ compensation

column in the savings report.