CMS Pub. 100-05, ch. 6, § 10.2

Following is a list of terms and their definitions used in MSP/CWF processing.

MSP Auxiliary File - Up to 17 beneficiary MSP occurrences/records on the CWF

database.

MSP Auxiliary Record - Record of beneficiary MSP information. One MSP

record/occurrence within the beneficiary's MSP auxiliary file.

Occurrence - One MSP occurrence/record within the beneficiary's MSP auxiliary file.

MSP Effective Date - Effective date of MSP coverage.

MSP Termination Date - Termination date of MSP coverage.

Validity Indicator

• Y - Beneficiary has MSP coverage (there is a primary insurer for this period of

time).

• N - No MSP coverage (the N validity indicator is no longer used, but will be seen

on older MSP CWF records)

• I - See §10.1.

• D – Deleted MSP Record

MSP Types - Reason for other coverage entitlement.

• A = Working Aged

• B = End stage renal disease (ESRD)

• D = Automobile/Liability No-Fault

• E = Workers' Compensation (WC)

• F = Federal, Public Health (note: currently not used)

• G = Disabled

• H = Black Lung (BL)

• L=Liability

• W=Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA)

NOTE: VA and other Federal payments are MSP exclusions rather than MSP nonpayments. Where the VA authorized services, Medicare does not make payment for items

or services furnished by a non-Federal provider pursuant to such an authorization.

Although certain MSP billing procedures apply, VA is not an MSP provision.

Cost Avoided Claim - A claim returned without payment because CWF indicators

indicate another insurer is primary to Medicare. (See Pub. 100-05, Chapter 5 for complete

description.)

Transaction Type - Identifies type of maintenance record.

• 0 = Transaction type to add or change MSP data

• 1 = Transaction type to delete MSP data

Override Code - Code used to bypass CWF, MSP edit to allow primary Medicare

payment. (See §40.4 for a detailed explanation.)

MSP Contractor Numbers

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

33333 = Litigation Settlement V 4000

P 55555 = HMO Rate Cell

Adjustment

U 3000

B,D,T,U,V,

or W

77777 = IRS/SSA/HCFA Data

Match (I, II, III, IV, V, or VI)

Y 1000

Q 88888 = Voluntary Data Sharing

Agreements

Q 5000

O 99999 = Initial Enrollment

Questionnaire

T 2000

MSP Contractor Numbers prior to January 1, 2001

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

0 11100 = MSP Contractor 6000

1 11101 = Initial Enrollment

Questionnaire

K 6010

2 11102 = IRS/SSA/CMS Data

Match

E 6020

3 11103 = HMO Rate Cell F 6030

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

4 11104 = Litigation Settlement G 6040

5 11105 = Employer Voluntary

Reporting

H 6050

6 11106 = Insurer Voluntary

Reporting

H 6060

7 11107 = First Claim

Development

E 6070

8 11108 = Trauma Code

Development

F 6080

9 11109 = Secondary Claims

Investigation

G 6090

X 11110 = Self Reports H 7000

Y 11111 = 411.25 J 7010

NOTE: Effective January 1, 2001, the following MSP Contractor numbers and

nonpayment/payment denial codes will be used.

MSP Contractor Numbers Effective January 1, 2001

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

0 11100 = MSP Contractor 00 Effective

4/1/2020

6000

1 11101 = Initial Enrollment

Questionnaire

T 6010

2 11102 = IRS/SSA/CMS Data

Match

Y 6020

3 11103 = HMO Rate Cell U 6030

4 11104 = Litigation Settlement V 6040

5 11105 = Employer Voluntary

Reporting

Q 6050

6 11106 = Insurer Voluntary

Reporting

K 6060

7 11107 = First Claim

Development

E 6070

8 11108 = Trauma Code

Development

F 6080

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

9 11109 = Secondary Claims

Investigation

G 6090

10 -

Effective

4/1/2002

11110 = Self Reports H 7000

11 -

Effective

4/1/2002

11111 = 411.25 J 7010

11101, 11102, 11103, 11104, and 11105 use the same non-payment denial codes as

their previous contractor numbers (i.e., 33333, 55555, 77777, 88888, 99999). Savings

from the old and new numbers, if applicable will be reported together (e.g., 11101

and 99999, etc). There must be a conversion of the MSP savings to the new nonpayment/payment denial codes as of January 1, 2001.

Additional MSP Contractor Numbers Effective April 1, 2002

Effective April 1, 2002, CWF is expanding the source code field and the

nonpayment/ payment denial code field from 1-position fields to 2-position fields.

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

12 11112 = Blue Cross-Blue Shield

Voluntary Data Sharing

Agreements

12 7012

13 11113 = Office of Personnel

Management (OPM) Data Match

13 7013

14 11114 = State Workers'

Compensation (WC) Data Match

14 7014

15 11115 = WC Insurer Voluntary

Data Sharing Agreements (WC

VDSA)

15 7015

16 11116 = Liability Insurer

Voluntary Data Sharing

Agreements (LIAB VDSA)

16 7016

17 11117 = Voluntary Data Sharing

Agreements (No Fault VDSA)

17 7017

CWF

Source

Codes

MSP Contractor Numbers

Nonpayment/

Payment

Denial Codes

CROWD Special

Project Numbers

18 11118 = Pharmacy Benefit

Manager Data

18 7018

19 11119 = Workers’ Compensation

Medicare Set-Aside Arrangement

19 7019

20 11120 = COBA 20 N/A

21 11121= MIR Group Health Plan 21 7021

22 11122= MIR Non-Group Health

Plan

22 7022

23 11123 = To be determined 23 7023

24 11124 = To be determined 24 7024

25 11125 = Recovery Audit

Contractor-California

25 7025

26 11126 = Recovery Audit

Contractor-Florida

26 7026

27 11127 = To be determined 27 7027

“” “” “” “”

39 11139 = GHP Recovery 39 7039

41 11141 =NGHP Non Ongoing

Responsibility for Medicals

(ORM)

41 7041

42 11142 = NGHP ORM Recovery 42 7042

43 11143 = MSP Contractor

/Medicare Part C/Medicare

Advantage

43 7043

“” “” “” “”

99 11199 = To be determined 99 7099