How do providers bill for MSP Conditional Payments?
The following conditions must be present if requesting a conditional payment: • MSP value code must be present with no amount listed. • Occurrence code 01, 02, 03, 04 or 24 must be present • First payer ID on page 4 must = C • Insurer name must be present and matches CWF • Remarks must be present with a valid reason for requesting conditional payment ***If adjusting a claim for a conditional payment, a D9 condition code must be used. The D9 is only to be used when it is an adjustment for a conditional payment. The conditional payment is given when the primary insurance (GHP or a Liability insurance) denies the claim in whole or when the liability insurance has not responded to the provider and it has been over 120 days since the date of the claim. All other situations should either be a D7-adjustment to make Medicare Secondary (MSP value code and amount of the primary payment is more than $0.00) or D8-adjustment to make Medicare primary (CWF is closed). ***If remarks are not valid the
