DELAY IN IMPLEMENTATION OF AUTOMATED MEDICARE SECONDARY PAYER ADJUSTMENTS (CR 6625)

On Friday, July 1, CMS implemented change request (CR) 6625 that created a systematic process in which Medicare automatically reopens/adjusts certain Medicare Secondary Payer (MSP) claims when a beneficiary’s MSP claims record was deleted or an end date was applied to an open beneficiary MSP record. This automated process no longer required physicians, providers, and suppliers to contact their Medicare contractors to adjust or reprocess these types of MSP claims. Due to systems issues currently affecting CR 6625, CMS directed its A/B Medicare administrative contractors, and legacy contractors (fiscal intermediaries (FIs) and carriers) to immediately suspend all actions on this CR. This means that our Medicare contractors are unable to automatically reopen/adjust claims when Medicare takes action to delete or terminate a previously existing MSP record. Physicians, providers, and suppliers must revert to the pre-July 1 process and contact their Medicare contractor to request re-openings/adjustments of claims that were previously considered MSP. Therefore, if you have claims that were processed since July 1 that need to be reopened/ adjusted due to Medicare now being the primary payer, you should contact your local Medicare contractor to request that action.