Reason Code U680H - JE Part A

Reason Code Narrative

THIS RECORD CONTAINS NO MSP AND AN MSP AUXILIARY RECORD EXISTS AT THE HOST. A COMPARE OF THE 03 TRAILER HAS BEEN COMPLETED AND THE FIRST OCCURRENCE WITH A 'Y' OR 'I' VALIDITY AND THE CLAIM DATES OF SERVICE ARE WITHIN THIS PAYORS EFFECTIVE AND TERMINATION DATES.

Common Reason Code Errors

• Claims are billed Medicare primary; however, an open Black Lung file exists on CWF.

Common Reason Code Corrections

• Collect primary insurer information from beneficiary and resubmit claim electronically, with correct primary payer information and Medicare as secondary payer.
• Black Lung payments should be reflected with:
  • Value code 41
• If claim is not related to open Black Lung file, resubmit claim including detailed remarks explaining why claim is not related.
• If primary payer is denying payment on claim, resubmit claim including detailed remarks explaining why Black Lung did not pay (benefits exhausted, not related, etc.).
• Conditional billing requires:
  • Occurrence code 24 with date of insurance denial
  • Medicare listed as secondary payer
  • Value code 41 with a $0.00 amount

Resource

• CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3, Section 30.2.3

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