J11 Part A Medicare Secondary Payer (MSP ... - Palmetto GBA

Billing Procedures for No-Fault and LiabilityMarch 2011Determine if services are the result of an accident.Bill all no-fault and liability insurers first.If liability is involved, obtain information andattempt to collect for 120 days.After 120 day period, you may request a conditionalpayment.Withdraw any claim you have with the liabilityinsurer.Bill Medicare showing any accident-related primarypayments using Value Codes 14 or 47, asappropriate.64Requesting a ConditionalPaymentA provider may file for conditional payment fromMedicare for services for which another payer isresponsible.If payment has not been made or cannot be expectedto be made promptly by the other payer, Medicaremay make conditional payment.Conditional payments are subject to repayment whenthe primary plan makes payment.March 201165Requesting a ConditionalPaymentTwo scenarios under which a provider mayfile for conditional payment:• No payment received from Group Health Plan(GHP)• No prompt payment received from liabilityinsurance Prompt means that payment is not received within 120daysMarch 20116622