Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.  See 42 U.S.C. 1395y(b) [section 1862(b) of the Social Security Act], and 42 C.F.R. Part 411, for the applicable statutory and regulatory provisions.

Workers’ Compensation (WC) insurance is a primary payer to the Medicare program for Medicare beneficiaries’ work-related illnesses or injuries; however, if all or part of a claim is denied by workers’ compensation, a claim may be filed with Medicare. Medicare may pay a claim that relates to a medical item or service covered by Medicare if the claim is not covered by workers’ compensation.

Also, when there is evidence that the workers’ compensation plan will not pay promptly, Medicare may make a conditional payment. A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so that the beneficiary won’t have to use his own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare when a settlement, judgment, award or other payment is made. 

If Medicare makes a conditional payment for an item or service, and you get a settlement, judgment, award, or other payment for that item or service from the WC insurance company later, the conditional payment must be repaid to Medicare. You’re responsible for making sure Medicare gets repaid for the conditional payment.

The Centers for Medicare & Medicaid Services (CMS) recommends the following for Medicare beneficiaries:

If Medicare makes a conditional payment, you or your representative should call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627. TTY users should call 1-855-797-2627. The BCRC will work on your case, using the information you or your representative gives it to see that Medicare gets repaid for the conditional payments.

The BCRC will gather information about any conditional payments Medicare made related to your pending settlement, judgment, award, or other payment. Once a settlement, judgment, award or other payment is final, you or your representative should call the BCRC. The BCRC will get the final repayment amount (if any) on your case and issue a letter requesting repayment.

BCRC Customer Service Representatives are available to assist you Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays, at toll-free lines: 1-855-798-2627 (TTY/TDD: 1-855-797-2627 for the hearing and speech impaired).

Access the CMS Medicare Secondary Payer Recovery Portal .

Note: if you are a Medicare beneficiary with a Maine WC case and Medicare is erroneously denying claims unrelated to the WC case, the CMS Boston Regional Office (BOSRO) maintains a public service phone line for this purpose.  Medicare beneficiaries having this type of problem should call (617) 565-4630.  When reporting this type of problem, the beneficiary should be able to provide their Medicare health insurance claim number (HICN), a description of the injuries related to the WC case and the dates of service of the claims that have been erroneously denied.  With this information, the BOSRO will fully investigate the matter and take appropriate corrective action.  The office will also provide the beneficiary with an explanation of the action taken and provide CMS staff contact information should any follow-up become necessary.