Reason Code U6825 - JE Part A

Reason Code Narrative

NON-GHP MSP CONDITIONAL PAYMENT CLAIM, BUT A NON-GHP MSP RECORD WITH A VALIDITY INDICATOR EQUAL TO 'I' OR 'Y' IS NOT PRESENT FOR THESE DATES OF SERVICE.

Common Reason Code Errors

• A claim is billed for Medicare conditional payment; however, there are no valid Non-Group Health Plan (GHP) files listed on Common Working File (CWF).
• A claim is billed for Medicare conditional payment and there is a valid Non-GHP file on CWF; however, claim is missing a 24 occurrence code.

Note: Non-GHP files are also referred to as Third Party Liability (TPL) files. MSP TPL files are No-Fault (value code 14), Liability (value code 47), Workers' Compensation (value code 15) and Black Lung (value code 41).

Common Reason Code Corrections

• Contact Benefits Coordination and Recovery Center (BCRC) to update Non-GHP file(s).
• Resubmit claim using the 24 occurrence code for conditional payment.

Resources

• Benefits Coordination & Recovery Center (BCRC)
• CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 3, 30.2 - Provider Billing Where Services Are Accident Related and No-Fault Insurance May Be Available

View reason code list, return to Reason Code Guidance page.