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.

Resource

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Last Updated May 22, 2018