Reason Code 34538 - JF Part A
Reason Code 34538
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.
- 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.
Last Updated Thu, 22 Dec 2022 18:52:46 +0000