CMS Pub. 100-05, ch. 6, § 20.1.1

The two situations in which the "add" maintenance transaction is used are:

• There is no MSP auxiliary file record for a beneficiary. In this case, the "add"

transaction creates an MSP auxiliary record containing the new MSP transaction

and sets the MSP indicator on the beneficiary's master record; or

• There is an MSP auxiliary file record but no matching occurrence for the

beneficiary. In this case, the "add" transaction adds the maintenance transaction as

a new occurrence.

The following fields are mandatory for a validity indicator of "Y" or "I" (Another insurer

is responsible for payment):

• Medicare beneficiary identifier;

• MSP type (MSP code);

• Validity indicator;

• MSP effective date;

• Contractor identification number;

• Insurer name (CWF will allow a space in the second position provided the third

position contains a valid character other than a space.);

• Patient relationship; and

• Insurance type.

A "Y" or "I" record CANNOT be established without the insurer name. Note, if the

Insurance Company Name is blank, or contains one of the abbreviated values that should

not be used as found in the ECRS manual, then it is considered an error.

NOTE: Although the insurer address cannot be MANDATORY, it should be provided

whenever possible.

The following are to be used as default values when creating an “I” record:

(1) MSP Effective Date: Use the Part A entitlement date.

(2) Patient Relationship: Use “01” if there is no indication of other insured member, and

use “02” if another member is shown, but uncertain of relationship.

(3) MSP Type: For GHP, use the current reason for entitlement: working aged (12),

disability (43), or ESRD (13). For NGHP, if not identified, the default to be used is No-Fault (14).