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
- Benefits Coordination & Recovery Center (BCRC)
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 3, 30.2 – Provider Billing Where Services Are Accident Related and No-Fault Insurance May Be Available
View reason code list, return to Reason Code Guidance page.
Last Updated May 22, 2018