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

  • Claim is billed for Medicare conditional payment; however, there are no valid Group Health Plan (GHP) files listed in Common Working File (CWF)
  • Claim is billed for Medicare conditional payment and there is a valid GHP file on CWF; however, 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 May 22, 2018