General Provider Information
Instructions For Requesting Medicare Secondary Payer (MSP) Adjustments
In order to provide better customer service, reduce phone calls, and have you provide appropriate documentation, we have developed a new process for requesting MSP adjustments. This will allow the MSP Department to more efficiently adjust your claims.
MSP Adjustments (type of bill xx7) can be submitted EMC or hardcopy. Effective November 1, 2003, MSP adjustments were no longer accepted via fax.
For faster processing of your adjustments we encourage you to submit your adjustments via EMC.
Mail the information to:
WPS Medicare
Medicare Secondary Payer
PO Box 8799
Madison WI 53708-8799
As the provider, you are responsible for checking the MSP screen on Common Working File (CWF) to ensure the information is accurate. If the information is correct, you may proceed with requesting your adjustment. If the screen is incorrect, you must call the Coordination of Benefits Contractor (COB) at 1-800-999-1118 to update the CWF. Once the screen has been updated by (COB) you may proceed with requesting your adjustment. Until this has been done by COB, our MSP Department is unable to adjust the denied claims and unable to assist you. However, if you do not have access to CWF you may contact the MSP Department at 1-866-518-3284 and we will check CWF for you.
For IRS/SSA/Data Match you must send a letter from the employer (on their letterhead) to the COB Contractor at the following address:
Coordination of Benefits Contractor
PO Box 5041
New York, NY 10274-5041
Below are a few of the most frequent MSP situations for submitting an adjustment, but are not limited to. For additional information, please refer to Medicare Claims Processing Manual, Pub 100-4, Chapter 3, Section 50.2.
- The claim was denied, and now it has been determined that Medicare is primary.
- The claim was processed as Medicare primary and payment was received from other insurer.
- The claim was denied and the retirement date for working aged, or last date worked for disability were given.
- " IRS/SSA/Data Match - When a claim was denied with denial code 35-40 and Medicare should have been primary. If Workers' Compensation denied the claim, you must send a copy of the denial letter with the adjustment request.
Page Last Updated: Tuesday, 29-Dec-2009 13:36:00 CST
