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MSP Rules Matrix Online
A reference tool has been developed to simplify
the application of Medicare Secondary Payer rules
and help identify the primary claims payer in most
Medicare situations. Four criteria are used to determine
whether a company’s plan or Medicare is the
primary or secondary payer:
- total number of employees
- reason for Medicare entitlement
- subscriber’s employment status
- plan paying primary prior to End Stage Renal
Disease (if applicable)
Key rules and the criteria are explained on the
reverse side of the matrix.
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