Medicare Secondary Claim Development Questionnaire

The Secondary Claim Development (SCD) Questionnaire is a Medicare Secondary Payer (MSP) questionnaire that is sent to obtain information about other insurers that may pay before Medicare. The SCD is mailed when a claim is submitted to Medicare with an explanation of benefits (EOB) attached, a self-report is made by you or your attorney identifying an MSP situation, or a third party payer submits MSP information to a contractor, or the Coordination of Benefits (COB) Contractor. This questionnaire asks:

1. If you have other health care coverage based upon your current employment;
2. If you are receiving black lung benefits, workers' compensation benefits, or treatment for an injury or illness for which another party could be held liable, or are covered under automobile no-fault insurance; and
3. If you have other health care coverage based upon a family member's current employment.

When you return the SCD in a timely manner, you help ensure correct payment of your Medicare claims.

View sample SCD Questionnaires under downloads.

Contact the COB Contractor's Customer Service Department using our toll-free lines: 1-800-999-1118 or TTY/TDD: 1-800-318-8782 for the hearing and speech impaired with any questions you have. Representatives are available to assist you Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays.