100-05 Medicare Secondary Payer Manual: Chapter 5.2 - ECRS Quick Reference Card
us-cms-medicare-manuals-pub-100-05-msp105c05_att2pdf100-05 Medicare Secondary Payer Manual: Chapter 5.2 - ECRS Quick Reference CardGuidance
1 Electronic Correspondence Referral System for the Web (ECRS Web) Quick Reference Card Rev. 2026/13 April CWF Assistance Request Codes Enter CWF assistance requests for existing MSP records Table 1: Required Fields on CWF Assistance Request Detail Pages Field Description DCN Document Control Number MEDICARE ID Beneficiary’s Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) ACTIVITY CODE Activity code ACTION(S) Action codes SOURCE Source of request information IMPORT HIMR MSP DATA Select to import HIMR data for the existing MSP record MSP TYPE Type of MSP coverage PATIENT RELATIONSHIP Patient relationship Field Description AUXILIARY RECORD # Record number of MSP auxiliary occurrence at CWF Note: Part D contractors must enter “001” when the Auxiliary record number is unknown. ORIGINATING CONTRACTOR Contract number of contractors that created original MSP occurrence at CWF EFFECTIVE DATE Effective date of MSP coverage TERMINATION DATE Date MSP coverage ended FIRST NAME Informant’s first name LAST NAME Informant’s last name ADDRESS Informant’s address CITY Informant’s city STATE Informant’s state ZIP Informant’s zip code RELATIONSHIP Informant’s relationship to the beneficiary INSURANCE COMPANY NAME Insurance company name INSURANCE TYPE Type of insurance coverage POLICY NUMBER Insurance policy number (not required if group number is entered) GROUP NUMBER Insurance policy group number (not required if policy number is entered) Field Description EMPLOYER NAME Name of the beneficiary’s employer ADDRESS Employer’s address CITY Employer’s city STATE Employer’s state ZIP Employer’s zip code CHECK NUMBER Check number CHECK DATE Date on the check CHECK AMOUNT Amount of the check PRE-PAID HEALTH PLAN DATE Pre-paid Health Plan date SOCIAL SECURITY NUMBER Beneficiary’s social security number DIAGNOSIS CODES Diagnosis codes Required when ACTION is DX. ICD Indicator Type of diagnosis code. Select “ICD-9” or “ICD- 10”. Required if corresponding Diagnosis Code is submitted. REMARKS Remarks Table 2: Required Fields for Source Codes on CWF Assistance Requests Value Required Fields CHEK FIRST NAME LAST NAME ADDRESS CITY STATE ZIP RELATIONSHIP CHECK NUMBER CHECK DATE CHECK AMOUNT LTTR FIRST NAME LAST NAME ADDRESS CITY STATE ZIP RELATIONSHIP PHON FIRST NAME LAST NAME ADDRESS CITY STATE ZIP RELATIONSHIP
2 Table 3: Related Action Codes on CWF Assistance Requests Value Description AI Change attorney information AP Add policy and/or group number AR Add CWF remark codes CD Change date of injury/date of loss CP Incorrect ESRD Coordination Period CT Change termination date CX Change Prescription Values (BIN, Group, PCN) DA Develop for attorney information DD Develop for the diagnosis code DE Develop for employer information DI Develop for insurer information DO Mark occurrence for deletion DR Investigate closed or deleted record DT Develop for termination date DX Change diagnosis codes EA Change employer address ED Change effective date EF Develop for the effective date EI Change employer information ES Employer size below minimum (20 for working aged; 100 for disability) ID Investigate possible duplicate for deletion II Change insurer information IT Change insurer type Value Description LR Create duplicate liability record MT Change MSP type MX SSN/Medicare ID mismatch NR Create duplicate no-fault record OH Change effective date of other drug coverage PC Update prescription person code PH Add PHP date PN Develop for/add PCN PR Change patient relationship TD Add termination date VP Update a record for a vow of poverty WN Notify BCRC of updates to WCMSA cases Table 4: Required Fields for Action Codes on CWF Assistance Requests Value Required Fields Description AI INFORMANT FIRST NAME, INFORMANT LAST NAME, INFORMANT CITY, INFORMANT STATE, INFORMANT ZIP, INFORMANT RELATIONSHIP (must be ‘A’), INSURANCE TYPE Attorney information Value Required Fields Description AP POLICY NUMBER and/or GROUP NUMBER INSURANCE TYPE Note: available for EGHP MSP types only Insurer information for drug records Insurance Type AR REMARK Code (at least one) Remarks CD GROUP NUMBER Note: ** available for contractor 79001, NON EGHP MSP types D, E, L, and W only *** DOI/DOL changes CP Note: ** available for ESRD MSP type B only *** Verification of coordination period CT TERMINATION DATE INSURANCE TYPE Termination Date Insurance Type DX DIAGNOSIS CODES (at least one) Diagnosis codes EA EMPLOYER NAME Employer information ED EFF DATE NEW EFF DATE Effective Date New Effective Date EI EMPLOYER NAME, EMPLOYER ADDRESS, EMPLOYER CITY, EMPLOYER STATE, EMPLOYER ZIP Type data in all fields to update employer info at CWF. Employer information Value Required Fields Description II INSURANCE COMPANY NAME If you leave the following fields blank, the system overwrites the previous value on the MSP auxiliary record at CWF: STREET, CITY, ST, ZIP, GROUP NO, POLICY NO, SUBSCRIBER NAME Type data in all fields to update insurer info at CWF. Leave all fields blank to delete insurer info at CWF. Insurance Company Name IT INSURANCE TYPE NEW INSURANCE TYPE Insurance type New Insurance Type MT MSP TYPE NEW MSP TYPE MSP Type New MSP Type MX SOCIAL SECURITY NUMBER SSN/Medicare ID mismatch PH PRE-PAID HEALTH PLAN DATE Pre-paid Health Plan date PR PAT REL NEW PAT REL INSURANCE TYPE Patient Relationship New Patient Relationship Insurance Type TD TERMINATION DATE INSURANCE TYPE Termination date Insurance Type WN Note: ** available for Contractor 79001 only *** WCMSA Notification
3 Prescription Drug Assistance Request Codes Table 5: Required Fields for Source Codes on Prescription Drug Assistance Requests Value Required Fields CHEK INFORMANT FIRST NAME, INFORMANT LAST NAME, INFORMANT ADDRESS, INFORMANT CITY, INFORMANT STATE, INFORMANT ZIP, INFORMANT RELATIONSHIP, CHECK NUMBER, CHECK DATE, CHECK AMT LTTR INFORMANT FIRST NAME, INFORMANT LAST NAME, INFORMANT ADDRESS, INFORMANT CITY, INFORMANT STATE, INFORMANT ZIP, INFORMANT RELATIONSHIP PHON INFORMANT FIRST NAME, INFORMANT LAST NAME, INFORMANT ADDRESS, INFORMANT CITY, INFORMANT STATE, INFORMANT ZIP, INFORMANT RELATIONSHIP Table 6: Action Codes on Prescription Drug Assistance Requests Value Description AP Add policy and/or group number BN Develop for prescription BIN CT Change termination date CX Change prescription values (BIN, Group, PCN) DO Mark occurrence for deletion DR Investigate Closed or Deleted Record EA Change employer address ED Change effective date EI Change employer information GR Develop for group number II Change insurer information IT Change insurer type MT Change MSP type OH Change effective date of other drug coverage PC Update prescription person code PN Develop for/add PCN PR Change patient relationship TD Add termination date Table 7: Required Fields for Action Codes on Prescription Drug Assistance Requests Value Required Fields Description AP INFMT NAME, ADDRESS, CITY, ST, ZIP Informant information (when Source Type is Letter, Check, or Phone) - COVERAGE TYPE Coverage Type (when Policy Number, BIN, PCN, ID, Supplemental Type, or Person Code are entered) - POLICY NUMBER Policy Number OR Group Number - GROUP NUMBER Group Number required when Coverage Type=U CT TERM DATE Termination Date CX BIN, PCN, GROUP BIN, PCN, OR Group Number is required DR MSP TYPE MSP Type EA EMPLOYER NAME Employer Name ED NEW EFF DATE New Effective Date EI EMPLR NAME, ADDRESS, CITY, ST, ZIP Employer information IT INS TYPE NEW INS TYPE Insurance type New Insurance Type Value Required Fields Description MT MSP TYPE, NEW MSP TYPE, RECORD TYPE MSP Type New MSP Type Record Type (must be PRI) OH NEW EFFECTIVE DATE OF OTHER DRUG COVERAGE New Effective Date of Other Drug Coverage PR NEW PAT REL New Patient Relationship TD TERM DT Termination Date MSP Inquiry Codes Note: Action codes are not required for MSP inquiries. Table 8: Required Fields on MSP Inquiry Detail Pages Field Description DCN Document Control Number MEDICARE ID Beneficiary’s Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) ACTIVITY CODE Activity code SOURCE Source of request information
4 Field Description PATIENT RELATIONSHIP Patient’s relationship Note: required when action code is blank and MSP type is F; action code is CA and MSP type is L; or action code is CL and MSP type is D, E, or L. EFFECTIVE DATE Effective date of MSP coverage TERMINATION DATE Date MSP coverage ended CMS GROUPING CODE CMS grouping code FIRST NAME Informant’s first name LAST NAME Informant’s last name ADDRESS Informant’s address CITY Informant’s city STATE Informant’s state ZIP Informant’s zip code RELATIONSHIP Informant’s relationship to the beneficiary INSURANCE COMPANY NAME Name of beneficiary’s insurer ADDRESS LINE 1 First line of insurer’s address Note: required when Insurance Company Name is entered. CITY Insurer’s city Note: required when Insurance Company Name is entered. Field Description STATE Insurer’s state Note: required when Insurance Company Name is entered. ZIP Insurer’s zip code Note: required when Insurance Company Name is entered. INSURANCE TYPE Type of insurance EMPLOYER NAME Name of beneficiary’s employer Note: required when MSP Type is F and Send to CWF is Yes. ADDRESS Employer’s address Note: required when MSP Type is F and Send to CWF is Yes. CITY Employer’s city Note: required when MSP Type is F and Send to CWF is Yes. STATE Employer’s state Note: required when MSP Type is F and Send to CWF is Yes. ZIP Employer’s zip code Note: required when MSP Type is F and Send to CWF is Yes. CHECK NUMBER Check number CHECK AMOUNT Amount on the check CHECK DATE Date on the check Field Description DIAGNOSIS CODES Diagnosis codes Note: If the MSP Type is A, B, or G, the system will prevent the entry of diagnosis codes. ICD Indicator Type of diagnosis code. Select “ICD-9” or “ICD- 10”. Required if corresponding Diagnosis Code is submitted BIN BIN Note: required when Coverage Type is U or with Action Codes BN, GR, or PN (Effective July 2026). PCN PCN Note: required when Coverage Type is U or with Action Codes BN, GR, or PN (Effective July 2026). GROUP Group number Note: required when Coverage Type is U or with Action Codes BN, GR, or PN (Effective July 2026). ID ID number Note: required when Coverage Type is U or with Action Codes BN, GR, or PN (Effective July 2026). Field Description SUPPLEMENTAL TYPE Type of supplemental insurance Note: must be L when Record Type is Supplemental. PERSON CODE Person code Note: required when Record Type is Supplemental and Supplemental type is L.
5 Table 9: Related Action Codes on MSP Inquiries Value Description CA Class action suit CL Closed or settled case Table 10: Required Fields for Action Codes on MSP Inquiries Value Required Fields CA MSP TYPE PATIENT RELATIONSHIP (when MSP Type is L) EFFECTIVE DATE (when MSP Type is L) CMS GROUPING CODE (when MSP Type is L) INSURANCE COMPANY NAME, INSURANCE TYPE DIAGNOSIS CODES Informant Name, Address, City, State and Zip are required unless Insurance Company Address, City, State and Zip have been entered. Note: Must enter “A” as relationship if Informant information is entered. Value Required Fields CL MSP TYPE (must be D, E, or L) PATIENT RELATIONSHIP (must be D, E, or L) EFFECTIVE DATE (must be D, E, or L) TERMINATION DATE (must be D, E, or L) DIAGNOSIS CODES Informant Name, Address, City, State and Zip are required unless Insurance Company Address, City, State and Zip have been entered. Note: Must enter “A” as relationship if Informant information is entered. Table 11: Required Fields for Source Codes on MSP Inquiries Value Required Fields CHEK FIRST NAME LAST NAME ADDRESS CITY STATE ZIP RELATIONSHIP CHECK NUMBER CHECK AMOUNT CHECK DATE LTTR FIRST NAME LAST NAME ADDRESS CITY STATE ZIP RELATIONSHIP Value Required Fields PHON MSP TYPE FIRST NAME LAST NAME ADDRESS CITY STATE ZIP RELATIONSHIP Prescription Drug Inquiry Codes Table 12: Required Fields on Prescription Drug Inquiry Detail Pages Field Description DCN Document Control Number MEDICARE ID Beneficiary’s Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) ACTIVITY CODE Activity code SOURCE Source of request information MSP TYPE MSP type Note: Leave MSP Type blank when Record Type is Supplemental PATIENT RELATIONSHIP Patient’s relationship Note: required when action code is blank and MSP type is F. Field Description SEND TO MBD Select Yes to send inquiry to MBD SUBMTTER TYPE Submitter type CHECK NUMBER Check number CHECK DATE Date on the check CHECK AMOUNT Amount on the check INFORMANT FIRST NAME Informant’s first name INFORMANT LAST NAME Informant’s last name INFORMANT ADDRESS Informant’s address INFORMANT CITY Informant’s city INFORMANT STATE Informant’s state INFORMANT ZIP Informant’s zip code INFORMANT RELATIONSHIP Informant’s relationship to the beneficiary INSURANCE COMPANY NAME Name of the insurance carrier for drug coverage. EFFECTIVE DATE Effective date of prescription coverage TERMINATION DATE Date prescription coverage ends Note: automatically populated when Coverage Type is U. RECORD TYPE Prescription Drug Record type (Effective July 2026)
6 Field Description COVERAGE TYPE Prescription Drug Coverage type of insurance (Effective July 2026) BIN BIN Note: required when Coverage Type is U. PCN PCN Note: required when Coverage Type is U. GROUP Group number Note: required when Coverage Type is U. ID ID number Note: required when Coverage Type is U. PERSON CODE Person code Note: required when Record Type is Supplemental, or when Record Type is blank and Supplemental type is L. Table 13: Required Fields for Source Codes on Prescription Drug Inquiries Value Required Fields CHEK CHECK NUMBER CHECK DATE CHECK AMOUNT INFORMANT FIRST NAME INFORMANT ADDRESS INFORMANT CITY INFORMANT STATE INFORMANT ZIP INFORMANT RELATIONSHIP LTTR INFORMANT FIRST NAME INFORMANT ADDRESS INFORMANT CITY INFORMANT STATE INFORMANT ZIP INFORMANT RELATIONSHIP PHON INFORMANT FIRST NAME INFORMANT ADDRESS INFORMANT CITY INFORMANT STATE INFORMANT ZIP INFORMANT RELATIONSHIP Table 14: Prescription Drug Supplemental Type Codes on Prescription Drug Inquiries Value Description L Supplemental N Non-qualified SPAP P PAP Q Qualified SPAP Value Description R Charity S ADAP T Federal Government Programs 1 Medicaid 2 Tricare 3 Major Medical Table 15: Coverage Type Codes on Prescription Drug Inquiries Value Description U Drug Network V Drug Non-network Z Health Reimbursement account General Codes The following codes apply to CWF assistance requests, MSP inquiries, and workers’ compensation set-aside trust cases. Table 16: General - Activity Codes Value Description C Claims (Pre-Payment) (22001) D Debt Collection (42021) G Group Health Plan (42003) I General Inquiry (42004) N Liability, No-Fault, Workers’ Compensation, and Federal Tort Claim Act (FTCA) (42002) Table 17: General - MSP Type Codes (Non-EGHP) Value Description D Automobile Insurance, No Fault E Workers’ Compensation L Liability W Workers’ Compensation Set-Aside
7 Table 18: General - MSP Type Codes (EGHP) Value Description A Working Aged B End-Stage Renal Disease (ESRD) C Conditional Payment F Federal (Public) G Disabled H Black Lung I Veterans Table 19: General - Source Codes Value Description CHEK Unsolicited check LTTR Letter PHON Phone call SCLM Medicare Secondary Claim payment SRVY Survey (Part D only) Table 20: General - Status Codes Value Description CM Completed DE Delete (do not process) ECRS request HD Hold, individual not yet a Medicare beneficiary (WC) (RAC) IP In process, being edited by COB NW New, not yet read by COB Table 21: General - Reason Codes Value Description 01 Not yet read by BCRC, used with NW status 02 Being processed by BCRC, used with IP status 03 Under development by BCRC, used with IP status 04 Update sent to CWF, used with IP status 05 Error received from CWF, being resolved by BCRC, used with IP status 06 Sent to EDB for beneficiary info, used with IP status 07 Auditor follow-up development in progress, used with IP status 10 Not processing 11 Not yet eligible for Medicare, used with HD status 12 Needs diagnosis, used with HD status (for WC set-aside trust cases only) 13 Future-dated workers’ compensation case, used with HD status (for WC set-aside trust cases only) 14 Duplicate request, development already in process, used with HD status 15 Requested Prescription Drug action(s) accepted - Posted to MBD 30 No action taken per SEE approval - Medicare primary 31 Action code and comments conflict 32 Record terminated/deleted due to OBRA 93 Value Description 33 WCSA record – can only be updated by RO, record closed by CWF Analyst 34 Record is “N” validity – we do not develop for “N” records 36 Policy Holder Retired (G record) 37 Beneficiary verified existing record, no update needed 38 Outreach development already in process 45 Insufficient information to process, used with HD status (RAC only) 46 RAC did not update hold records, used with DE status (RAC only) 50 Requested action(s) accepted - Posted to CWF 51 No changes (additions, modifications, or deletions) made to CWF, used with CM status 52 Returned–rejected by CWF; conflicting information, used with CM status 53 Returned–duplicate ECRS request, used with CM status 54 100 or more thresholds met, Disability 55 20 or more thresholds met, Working Aged 56 OBRA does not apply, no update 57 Record already updated 58 Non-compliant GHP 59 Employer verified existing record, no update 60 Invalid Medicare ID 61 No Part A entitlement Value Description 62 Development letter sent, closed, no response to development 63 Development complete, no MSP 64 Development letter sent 65 Deceased, used with CM status 66 ESRD/DIB conflict 67 No response from CWF 68 Closed for Self-Report 69 Developed to GHP, no response 70 Developed to non-EGHP, no response 71 Developed to beneficiary; closed, no response received 72 Developed to informant, no response 73 Medicare beneficiary retired 74 Spouse retired 75 GHP lifetime of yearly benefits past maximum amount 76 No coverage with insurance company 77 Medicare Supplemental Plan 78 Employer has less than 20 employees (No MSP) 79 Per employer, Medicare beneficiary is not covered under spouse’s GHP 80 Employer has less than 100 employees (No MSP) 81 Medicare is primary due to ESRD coordination period being met 82 Per insurance, seasonal employee and not eligible for the month 83 Incoming request conflicts with information on file
8 Value Description 84 Missing information, unable to update CWF 85 Venue changed 86 Unable to verify address, used with CM status (for CWF assistant requests only) 87 MSP record exists, used with CM status (for MSP inquiries only) 88 No update, not lead contractor 91 Duplicate in process 92 Change of Venue not allowed after 90 days 93 No Part D Enrollment found 94 Closed, no response/no update 96 Per hierarchy guidelines, request cannot be honored. 97 Existing record is invalid and has been deleted. New record created to include changes requested. 98 Overlapping Rx Coverage Table 22: General - Patient Relationship Codes Value Description 01 Patient is policy holder 02 Spouse 03 Natural child, insured has financial responsibility 04 Natural child, insured has no financial responsibility 05 Stepchild 06 Foster child Value Description 07 Ward of the Court 08 Employee 09 Unknown 10 Handicapped dependent 11 Organ donor 12 Cadaver donor 13 Grandchild 14 Niece/nephew 15 Injured plaintiff 16 Sponsored dependent 17 Minor dependent of a minor dependent 18 Parent 19 Grandparent dependent 20 Domestic partner Table 23: General - Informant Relationship Codes Value Description A Attorney representing beneficiary B Beneficiary C Child D Defendant’s attorney E Employer F Father I Insurer M Mother N Non-relative O Other relative P Provider Value Description R Beneficiary representative (other than attorney) S Spouse U Unknown W Pharmacy Table 24: General - Relationship to Insured Codes Value Description B Beneficiary C Child E Employer F Father M Mother N Non-relative O Other relative S Spouse U Unknown Table 25: General - Insurance Type Codes Value Description A Insurance or Indemnity (OTHER TYPES) B Group Health Organization (GHO) C Preferred Provider Organization (PPO) D Third Party Administrator arrangement under an Administrative Service Only (ASO) contract without stop loss from any entity (TPA/ASO) Value Description E Third Party Administrator arrangement with stop loss insurance issued from any entity (STOP LOSS TPA) F Self-Insured/Self-Administered (SELF-INSURED) G Collectively-Bargained Health and Welfare Fund (HEALTH/WELFAR) H Multiple Employer Health Plan with at least one employer who has more than 100 full- and/or part-time employees (EMPLOYER+100) I Multiple Employer Health Plan with at least one employer who has more than 20 full- and/or part-time employees (EMPLOYER+20) J Hospitalization Only Plan covering inpatient hospital services (HOSPITAL ONLY) K Medical Services Only Plan covering only non-inpatient medical services (MEDICAL ONLY) R GHP Health Reimbursement Arrangement S GHP Health Savings Account Blank Unknown (UNKNOWN)
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