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Medicare secondary payer (MSP)

If Medicare pays primary for an employee or enrolled family member, Medicare may bill an agency directly to recover costs considered payable through the employer-sponsored coverage. Medicare holds employers primarily responsible for resolving MSP cases. As stated in the initial demand packet you may not transfer this responsibility to the group health plan (GHP), its insurer, or any other entity. So, although the Health Care Authority, PEBB and the health plan can provide help in resolving these cases with your permission, the Medicare still ultimately holds the agency responsible. The initial notices must be processed quickly but they do take time to research. Since we began our Voluntary Data Sharing Agreement (VDSA) with Medicare we have been able to dramatically reduce the number of MSP cases and are reporting the PEBB mailing address to Medicare so we can receive correspondence directly. So, hopefully you will not be seeing these demands for payment from Medicare. Just in case you do, below is an overview of the process.

The Centers for Medicare & Medicaid Services (CMS) Medicare Coordination of Benefits and Recovery (COB&R) and their Commercial Repayment Center (CRC) is the contractor for Medicare that issue demands for payment on MSP cases. If you receive a Medicare Secondary Payer Demand Packet from CMS and the COB&R, to avoid a penalty, immediately send all MSP notices (including secondary notices) along with the letter indicating the dates the employee and/or covered family members were eligible for PEBB coverage to HCA/PEBB using Fuze secure messaging. Timing is extremely critical on these demand packets. It is imperative that these do not sit on someone’s desk without action. For more information visit the CMS COB&R website.

Please make sure that you have a primary and secondary person who understands the process and can respond within the timeframes outlined in the letters you receive from CMS COB&R.

It cannot be over-emphasized the importance getting these resolved within the first 60 days if possible. This may mean that you need to train anyone receiving mail in your agency to recognize any of these letters sent by the CMS COB&R or the US Treasury, handle them with the highest priority, and get them to the right person in your agency to contact HCA Outreach and Training for assistance.

Note: Medicare data match requests must be completed by the employing agency.