--- title: Billing Medicare as the secondary payer description: When Medicare pays second, add the MSP insurance type code so the claim isn't rejected — where to set it in Pabau and which code to pick. --- [Skip to content](https://support.pabau.com/en/pabau2/billing-medicare-as-the-secondary-payer#main-content) [![pabau logo white](https://support.pabau.com/hubfs/pabau%20logo%20white.svg)](https://support.pabau.com/en/pabau2?hsLang=en) Open main navigation Close main navigation - [Get Support](https://pabau.com/support-center/) [Get Support](https://pabau.com/support-center/) Pabau Knowledge Base - There are no suggestions because the search field is empty. 1. [Pabau Knowledge Base](https://support.pabau.com/en/pabau2?hsLang=en) 2. [Insurance Billing](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en) 3. [Insurance Billing (US)](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en#insurance-billing-us) # Billing Medicare as the secondary payer When a patient has Medicare **and** other coverage that pays before it, Medicare pays second. Medicare will only accept a claim billed to it as the secondary payer if the claim says **why** Medicare pays second — that reason is the Medicare Secondary Payer (MSP) insurance type code. Leave it off and Medicare rejects the claim. Pabau lets you attach that code on the secondary claim itself, so you don't have to leave and submit it through the clearinghouse portal by hand. **NOTE:** *The insurance billing module is available for practices in the United States and works with your connected Claim.MD account. This code is only needed when the **secondary** payer is Medicare — every other payer ignores it.* ### Before you start The MSP code goes on a **secondary claim**, so the primary has to be settled first. You need: - The **primary claim in the Paid status**, carrying the primary payer's line-by-line adjudication — see [Submitting secondary claims in Pabau](https://support.pabau.com/en/pabau2/submitting-secondary-claims-in-pabau?hsLang=en) for how a secondary is created from a paid primary. - The patient's **Medicare details** on file as their second policy (payer and Medicare number). - To know **why Medicare is secondary** for this patient — that's what the code names (see the table below). It's usually obvious from the patient's situation: still working with an employer plan, an accident/no-fault claim, workers' comp, and so on. ### Adding the MSP type code Open the paid primary claim and click **Create secondary claim** in the claim's settlement bar (the status bar that starts with **Paid**). In the dialog: ![The settlement bar on a paid claim, showing the Create secondary claim button](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/claimmd-paid-strip-create-secondary.png) - Choose **Medicare** as the secondary payer and enter the patient's Medicare number (Pabau pre-fills it if the Medicare policy is on file). - Open the **Medicare secondary (MSP) type** dropdown and pick the reason Medicare pays second. It defaults to *Not Medicare / not applicable*, so it never gets in the way on an ordinary secondary claim. - Click **Submit secondary claim**. Pabau sends the claim to Claim.MD as a secondary with the primary payer's paid amounts and adjustment codes attached, plus the MSP type code Medicare needs. ![The secondary claim dialog with the Medicare secondary (MSP) type dropdown set to code 12](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/claimmd-secondary-modal-msp.png) **TIP:** *Only set this when the secondary payer really is Medicare. On a secondary claim to a commercial payer, leave it on **Not Medicare / not applicable**.* ### Which code to pick Pick the one that matches why Medicare is the secondary payer for this patient: - **12** — Working aged: the patient (or spouse) is still working and covered by an employer group health plan. - **13** — End-stage renal disease (ESRD), during the coordination period. - **14** — No-fault insurance, including auto. - **15** — Workers' compensation. - **16** — Public Health Service or another federal agency. - **41** — Black lung. - **42** — Veterans Affairs. - **43** — Disabled under 65 and covered by a large group health plan. - **47** — Liability insurance. **NOTE:** *If you're not sure which situation applies, the patient's primary insurer or Medicare can confirm it. The wrong code, or a missing one, is the usual reason a Medicare-secondary claim comes back rejected.* ### Tracking it The secondary rides on the same claim as the primary — the settlement bar shows both results side by side, and the claim's activity log records the secondary submission. 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