CMS Pub. 100-06, ch. 7, § 50.7

G – Control

Number

Control Objective – Medicare Secondary Payer (MSP)

G.1 Medicare Administrative Contractor internal quality controls are

established and maintained that ensure timely and accurate

processing of secondary claims submitted, including paper MSP

claims with a primary payer’s explanation of benefits (EOB) or

remittance advice (RA). This includes utilization of the MSPPAY

module, resolving all MSP edits (including 6800 codes*), creation

of “I” records and resolving suspended claims in accordance with

CMS instructions at Publication 100-05 Chapter 5 and 6. Contractor

internal systems used to process MSP claims are updated via the

Common Working File (CWF) automatic notice in an automated

fashion. Suspended claims that require manual intervention are

corrected and reviewed by the appropriate suspense staff.

This control objective does not pertain to BCRC or the CRC

contractors.

G – Control

Number

Control Objective – Medicare Secondary Payer (MSP)

G.2 Audit trails for MSP receivables are created and maintained. An

audit trail should include details of the source of the receivable,

correspondence in date order, reasons for adjustments, referral to

treasury, collection of the debt, and any information regarding the

establishing, reconciling and resolving a receivable for an

outstanding debt. All applicable systems (e.g. HIGLAS) should be

updated accurately and timely, and be accessible to the appropriate

individuals.

This control objective pertains to MACs, BCRC, and CRC

Contractors.

G.3.1 Contractors ensure compliance with all CMS instructions and

directives relating to MSP Investigations by the Benefit

Coordination & Recovery Center (BCRC). This includes the MACs

transmitting appropriate, timely and complete Electronic

Correspondence Referral System (ECRS) submissions in

accordance with Publication 100-05, CWF Assistance Requests and

ECRS MSP inquiries to the BCRC as a result of the receipt of a

phone call, correspondence, claim or unsolicited check/voluntary

refund. All references must be maintained in an area accessible to

MSP staff and must be available for CMS review.

*The ECRS user guide is located at: Publication # 100-05 The

Electronic Correspondence Referral System on the Web (ECRS

Web) User Guide.

This control objective does not pertain to the CRC Contractor

G.3.2 The Commercial Repayment Center (CRC) must transmit

appropriate, timely and complete ECRS submissions and CWF

Assistance Request as a result of a phone call, inquiry or

correspondence received to ensure debtor information is accurate.

The Benefits Coordination and Recovery Center (BCRC) must

respond to all ECRS Inquiry and Assistance Requests for all

contractors.

This control objective pertains to the CRC and the BCRC.

G – Control

Number

Control Objective – Medicare Secondary Payer (MSP)

G.4 Contractors identify and track all incoming correspondence to

ensure timely acknowledgement, response, and priority compliance

with the Statement of Work (SOW) for MACs and other Medicare

Contractors. All correspondence includes written inquiries,

including letters, faxes, telephone inquiries, e-mails and any other

forms of communication to support and complete a

correspondence/inquiry action, shall be handled consistently for

accuracy, professionalism and timeliness. These tracking

mechanisms should include the ability to track ECRS submissions

when awaiting response/status from the BCRC, or further actions

such as claims adjustments after the BCRC has completed their

investigation.

This control objective pertains to MACs, BCRC, and CRC

Contractors.

G.5 Contractors shall have quality assurance measures in place to ensure

the accuracy of the implementation of any CMS directive or any

required work process/deliverable expressed in the SOW.

Contractors shall also provide evidence that the results from quality

assurance checks are documented to identify errors and that training

venues are implemented to prevent the reoccurrence of these errors.

This control objective pertains to MACs, BCRC, and CRC

Contractors.

End Section 50.7 – G Controls – Medicare Secondary Payer (MSP): Back to Table of

Contents