Reason Code U680H - JE Part A
Reason Code U680H
Reason Code Narrative
THIS RECORD CONTAINS NO MSP AND AN MSP AUXILIARY RECORD EXISTS AT THE HOST. A COMPARE OF THE 03 TRAILER HAS BEEN COMPLETED AND THE FIRST OCCURRENCE WITH A 'Y' OR 'I' VALIDITY AND THE CLAIM DATES OF SERVICE ARE WITHIN THIS PAYORS EFFECTIVE AND TERMINATION DATES.
Common Reason Code Errors
- Claims are billed Medicare primary; however, an open Black Lung file exists on CWF.
Common Reason Code Corrections
- Collect primary insurer information from beneficiary and resubmit claim electronically, with correct primary payer information and Medicare as secondary payer.
- Black Lung payments should be reflected with:
- Value code 41
- If claim is not related to open Black Lung file, resubmit claim including detailed remarks explaining why claim is not related.
- If primary payer is denying payment on claim, resubmit claim including detailed remarks explaining why Black Lung did not pay (benefits exhausted, not related, etc.).
- Conditional billing requires:
- Occurrence code 24 with date of insurance denial
- Medicare listed as secondary payer
- Value code 41 with a $0.00 amount
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3, Section 30.2.3
View reason code list, return to Reason Code Guidance page.
Last Updated Wed, 04 Jan 2023 19:32:01 +0000