Reason Code 31409 - JE Part A

Reason Code Narrative

AN OCCURRENCE CODE 24 IS PRESENT ON THE CLAIM; HOWEVER, NO VALUE CODE IS PRESENT OR YOU ARE BILLING FOR A MEDICARE PRIMARY PAYMENT. THERE IS AN OCCURRENCE CODE 24 ON THE CLAIM AND YOUR REMARKS DO NOT SUFFICIENTLY EXPLAIN WHY THE PRIMARY INSURER DID NOT PAY THIS CLAIM.

Common Reason Code Errors

• Claims are billed for conditional Medicare payment; however, primary insurance value code is missing.
• Medicare is listed as primary payer with a 24 occurrence code (date primary insurance denied); however, should be listed as secondary payer.

Note: Conditional billing occurs when Medicare is secondary to a different insurance but primary either denied payment or applied all payment to deductible.

Common Reason Code Corrections

• Resubmit claim and indicate that Medicare is secondary to primary payer (use appropriate value code for primary insurance and 24 occurrence code for primary insurance denial date). Include detailed remarks indicating why primary payer denied payment.

Resource

• CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 6

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