Reason Code U680E - JF Part A
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 Tue, 22 May 2018 10:51:28 +0000