Reason Code U6825

Reason Code Narrative

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

Note: Non-GHP files are also referred to as Third Party Liability (TPL) files. MSP TPL files are No-Fault (value code 14), Liability (value code 47), Workers' Compensation (value code 15) and Black Lung (value code 41).

Common Reason Code Corrections

  • Contact Benefits Coordination and Recovery Center (BCRC) to update Non-GHP file(s).
  • 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 15:23:14 +0000