US · guidance
CMS Pub. 100-05, ch. 6, § 40.9
CWF MSP Reject for A Beneficiary Entitled to Medicare Part B
Only and A GHP
(Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23)
An MSP situation cannot exist when a beneficiary has GHP coverage (i.e., working aged,
disability and ESRD) and is entitled to Part B only. CWF will edit to prevent the posting
of these MSP records to CWF when there is no Part A entitlement date. Currently, if a
contractor submits an ECRS transaction to the MSP Contractor to add a GHP MSP record
where there is no Part A entitlement, the A/B MAC and DME MAC will receive a reason
code of 61, MSP cannot exist without Part A entitlement.
A/B MACs and DME MACs shall not submit an ECRS request to the MSP Contractor to
establish a GHP MSP record when there is no Part A entitlement. A/B MACs and DME
MACs that attempt to establish an “I” record will receive a CWF error.
The CWF shall continue to allow the posting of Part B MSP records where there is no
Part A entitlement when NGHP situations exists, such as automobile, liability, and
workers’ compensation. Where an NGHP situation exists, the A/B MAC and DME
MAC shall continue to submit ECRS transactions and establish “I” records, as necessary.
History
(Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0a6cc5fc5f910e09abb82b8c5f242fdda023116b27eb47412834b89a84e0329e
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