Reason Code U6805 - JE Part A

Reason Code Narrative

GHP MSP CONDITIONAL PAYMENT CLAIM, BUT A 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 Group Health Plan (GHP) files listed on the Common Working File (CWF).
• A claim is billed for Medicare conditional payment and there is a valid GHP file on CWF; however, the claim is missing a 24 occurrence code.

Note: GHP files are Working Aged (value code 12), Disabled (value code 43) and End Stage Renal Disease (ESRD) (value code 13).

Common Reason Code Corrections

• Contact Benefits Coordination and Recovery Center (BCRC) to update GHP file.
• 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.