Reason Code 34538 - JE Part A

Reason Code Narrative

CLAIM SUBMITTED AS MEDICARE PRIMARY AND A POSITIVE WORKING ELDERLY RECORD EXISTS AT CWF. THE CONTRACTOR ID IS EQUAL TO ‘11121.' THE CLAIM SHOULD BE BILLED TO THE EMPLOYER GROUP HEALTH PLAN.

Common Reason Code Errors

• Claim was submitted as Medicare primary, however CWF shows an open working aged record.

Common Reason Code Corrections

• Collect primary insurer information from beneficiary and resubmit claim with correct primary payer and Medicare as secondary information.
• If beneficiary no longer has other primary insurance, contact Benefits Coordination and Recovery Center (BCRC) to update working aged file.

Resources

• CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3
• CMS Coordination of Benefits & Recovery Contacts

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