CMS Pub. 100-05, ch. 6, § 20.2

MAC MSP Auxiliary File Update Responsibility

(Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23)

The capability to update the CWF MSP auxiliary file is essentially a function of only the

MSP Contractor. The A/B MAC and DME MACs do not have the capability to delete

any MSP auxiliary file records, including those that a specific A/B MAC or DME MAC

established. If it is believed that a record should be changed or deleted, A/B MACs and

DME MACs use the MSP Contractor via the ECRS (discussed in Pub. 100-05, Chapter 5,

CWF Assistance Request option, to notify the MSP Contractor of the needed revision.

A/B MACs and DME MACs process claims in accordance with existing claims

processing guidelines.

There are only two instances in which A/B MACs and DME MACs retain the capability

to update CWF. They are:

A. A claim is received for secondary benefits and the contractor could, without further

development (for example, the EOB from another insurer or third-party payer contains all

necessary data), add an MSP occurrence and pay the secondary claim. A/B MACs must

use a validity indicator of "I" to add new MSP occurrences and update CWF. An “I”

record is to be added to the CWF within 10 calendar days when the claim is suspended

for MSP (internal system or CWF, whichever suspends first) if no MSP record with the

same MSP type already exists in CWF. Note: Effective October 1, 2021, DME MACs no

longer submit“I”records and instead submit an Electronic Correspondence Referral

System (ECRS) Inquiry to create an MSP record. A/B MACs cannot submit a new record

with a "Y" or any record with an "N" validity indicator.

B. A claim is received for conditional payment, and the claim contains sufficient

information to create an "I" record without further development. A/B MACs add the MSP

occurrence using an "I" validity indicator. An “I” record is to be added to the CWF within

10 calendar days when the claim is suspended for MSP (internal system or CWF,

whichever suspends first) if no MSP record with the same MSP type already exists in

CWF.

A/B MACs will transmit "I" records to CWF via the current HUSP transaction. The CWF

will treat the "I" validity indicator the same as a "Y" validity indicator when processing

claims. Receipt of an "I" validity indicator will result in a CWF trigger to the MSP

Contractor. The MSP contractor will develop and confirm all "I" maintenance

transactions established by the A/B MAC. If the MSP contractor receives an affirmative

confirmation of MSP through its development efforts within 45 calendar days, the MSP

contractor will convert the “I” to a “Y” validity indicator. If the MSP contractor has not

received confirmation of MSP through its development efforts within 45 calendar days,

the MSP contractor will automatically delete the "I" validity indicator. Also, if the MSP

contractor develops and determines there is no MSP, the MSP Contractor will delete the

"I" record. An "I" record should never be established when the mandatory fields of

information are not readily available to an A/B MAC on a claim attachment. If the A/B

MAC has the actual date that Medicare became secondary payer, they use that as the

MSP effective date. If that information is not available, the A/B MAC shall use the Part

A entitlement date as the GHP MSP effective date. A/B MACs may include a termination

date when they initially establish an "I" record. However, they may not add a termination

date to an already established "I" record.

CWF accepts an "I" record only if no MSP record (validity indicator of either "I" or "Y,"

open, closed, or deleted status) with the same MSP type already exists on CWF with an

effective date within 45 calendar days of the effective date of the incoming "I" record.

Therefore, "I" records submitted to CWF before 45 calendar days have elapsed will reject

with an SP 20 error code. The resolution for these cases is to transfer all available

information to the MSP contractor via the Electronic Correspondence Referral System

(ECRS) CWF assistance request screen. It will be the responsibility of the MSP

contractor to reconcile the discrepancy and make any necessary modifications to the

CWF auxiliary file record.

A refund or returned check is no longer a justification for submission of an "I" record.

Since an "I" record does not contain the source (name and address) of the entity that

returned the funds, the MSP contractor lacks the information necessary to develop to that

source. Follow the examples below to determine which ECRS transaction to submit.

1. An MSP inquiry should be submitted when there is no existing or related MSP record

on the CWF. A “related” record means if an MSP record on CWF matches and has the

same HICN/MBI, MSP type, MSP effective date, Insurance type, patient relationship

code, and validity indicator.

2. The CWF assistance request should be submitted when the information on the CWF is

incorrect or the MSP record has been deleted.

3. The check or voluntary refund either opens and/or closes the MSP case or MSP issue.

Under these circumstances, the A/B MACs or DME MACs shall submit an MSP inquiry

to open or close the MSP record. Note: The A/B MACs or DME MACs should refer to

the ECRS manual for more information regarding closed cases.

The check should be deposited to unapplied cash until the MSP contractor makes an MSP

determination.