Medicare is Secondary Payer

CARC/RARC Description
CO-16 Claim/service lacks information or has submission/billing error(s) which is needed for adjudication.

MA04

Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.

 

Common Reasons for Message

  • Incorrect primary payer type was submitted on an electronic claim
  • A claim has been submitted as Medicare secondary and national file shows Medicare is primary

Next Step

  • Verify whether Medicare is primary or secondary
  • Claim may be resubmitted with corrected information
    • If Medicare is secondary, verify correct primary insurance type was submitted in loop 2000B SBR02
    • If Medicare is primary, verify no MSP information was billed on claim

Claim Submission Tips

  • Prior to submitting claim(s), verify patients' eligibility via Interactive Voice Response (IVR) or the Noridian Medicare Portal
    • If there is a problem with file, patient may contact Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 to make necessary corrections
  • For electronic claims, verify that all necessary primary information is correctly submitted on claim

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

 

Last Updated May 11, 2018