Reason Code U680E - JF Part A

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

• 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.