You may at some point receive a letter from the Centers for Medicare and Medicaid Services (CMS) regarding a Medicare Secondary Payer (MSP) debt. Such a letter is usually sent because Medicare may have made primary payments for services furnished to Medicare beneficiaries that it believes should have been the primary payment responsibility of the group health plan.
Please note that the law makes all entities responsible for payment under a group health plan jointly and severally responsible for resolving these debts. These entities include the employer sponsoring the group health plan. However, CMS will only mail this information directly to employers. Blue Cross of Northeastern Pennsylvania can help you, should you receive such a letter for a subscriber who was covered under a Blue Cross contract/policy at the time the services were received.
We will research to determine if the group health plan or Medicare is the primary payer. We will then review each claim to see if we already paid the provider, compile the benefit and applicable precertification/referral information, and will either send a letter to CMS with our rebuttal (with full documentation) on why the debt is not owed, or we'll process the claims to pay the CMS agency noted in the demand letter. This research and rebuttal/claims adjudication may take up to 60 days.
If you receive an MSP demand letter, please send us the full packet of information, including the letter, the MSP Summary Data Sheet, the Potential Savings Report, claims facsimiles and any additional notices/letters you may receive. Be sure to send both sides of all pages to insure that all information is received. Mail the packet to:
Blue Cross of Northeastern Pennsylvania
BCNEPA Claims - MSP Coordinator
19 North Main Street
Wilkes-Barre, PA 18711
If you have questions about MSP demands, please visit http://www.cms.gov and click on the "Medicare Secondary Payer Manual" or call the number listed within the demand letter.