Reason Code U6805

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

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

 

Last Updated Wed, 26 Feb 2020 15:22:09 +0000