Reason Code U680E
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 Workers' Compensation file exists in 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
- Workers Comp payments should be reflected with value code 15
- Occurrence code 04 with date of accident or injury
- If claim is not related to open Workers' Compensation file, resubmit claim including detailed remarks explaining that claim is not related
- If primary payer is denying payment on claim, resubmit claim including detailed remarks explaining why Workers Comp did not pay (benefits exhausted, not related, etc.)
- Conditional billing requires:
- Occurrence code 24
- Medicare listed as secondary payer
- Value code 15 with a $0.00 amount
- Occurrence code 04
Note: Workers Comp payments should be reflected with value code 15 and occurrence code 04 with date of loss.
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer (MSP) Manual, Chapter 3, Section 30.2.2
View reason code list, return to Reason Code Guidance page.
Last Updated May 22, 2018