Reason Code U680H

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 Black Lung 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
  • Black Lung payments should be reflected with:
    • Value code 41
  • If claim is not related to open Black Lung file, resubmit claim including detailed remarks explaining why claim is not related
  • If primary payer is denying payment on claim, resubmit claim including detailed remarks explaining why Black Lung did not pay (benefits exhausted, not related, etc.)
  • Conditional billing requires:
    • Occurrence code 24 with date of insurance denial
    • Medicare listed as secondary payer
    • Value code 41 with a $0.00 amount

Resource

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Last Updated May 22, 2018