Reason Code U680L

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 PAYER'S EFFECTIVE AND TERMINATION DATES.

Common Reason Code Errors

  • Claims are billed Medicare primary; however, an open Liability 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
    • Reflect Liability payments with value code 47
    • The applicable occurrence code with date of accident or injury
      • 01 - Accident/Medical Coverage
      • 02 - No-Fault Insurance Involved, including auto accident
      • 03 - Accident/TORT liability
  • If claim is not related to open Liability file, resubmit claim including detailed remarks explaining claim is not related
  • If primary payer is denying payment on claim, resubmit claim including detailed remarks explaining why Liability insurance did not pay (benefits exhausted, no med pay, etc.)
    • Conditional billing requires
      • Occurrence code 24 with date of insurance denial
      • Medicare listed as secondary payer
      • Value code 47 with a $0.00 amount
      • Appropriate occurrence code
  • If beneficiary will not provide primary insurance information, resubmit claim with a 08 condition code and a detailed remark explaining why beneficiary will not or cannot provide primary insurance information

Resource

View reason code list, return to Reason Code Guidance page.
 

Last Updated Tue, 22 May 2018 10:58:07 +0000