PA/MD vs NJ Reason Code Compare (8/25/2008)

Medicare Secondary Payer (MSP) reason codes for New Jersey have been compared to Pennsylvania and Maryland and consolidated into one consistent list as required of the Medicare Administrative Contractor (MAC). These reason codes reflect various MSPPAY, or pricing issues, as well as MSP cost avoid denials because the Common Working File (CWF) indicates the beneficiary has other insurance coverage that is primary to Medicare. The following reason code statuses will be changed as of September 1, 2008. Abbreviations were used to document status:

A = inactive, T = Return to Provider, R = Reject, S = Suspend

MSP Reason Code	Description	Current Status	New Status
33506	MSP total coinsurance is greater than zero	S	T
33510	MSP claim missing one of the following: valid payer ID primary payer amount occurrence code 24 – conditional payment	S	T
33560	MSPPAY error – blood deductible	S	T
33570	MSPPAY error – non-numeric data in value A1, B1 or C1	S	T
33580	MSPPAY error – non-numeric data in regular coinsurance rate	S	T
33590	MSPPAY error – non-numeric data in regular coinsurance rate	S	T
33600	MSPPAY error – non-numeric data in value A2, B2 or C2	S	T
33610	MSPPAY error – non-numeric data in regular coinsurance rate	S	T
33620	MSPPAY error – non-numeric data in regular coinsurance rate	S	T
33630	MSPPAY error – non-numeric data in value A2, B2 or C2	S	T
33640	MSPPAY error – non-numeric data in regular lifetime reserve days	S	T
33650	MSPPAY error – non-numeric data in regular lifetime reserve rate	S	T
33660	MSPPAY error – non-numeric data in regular lifetime reserve amount	S	T
33670	MSPPAY error – non-numeric data in regular lifetime reserve days	S	T
33680	MSPPAY error – non-numeric data in regular lifetime reserve rate	S	T
33690	MSPPAY error – non-numeric data in regular lifetime reserve amount	S	T
33710	MSPPAY error – non-numeric data in value code A2, B2 or C2	S	T
33720	MSPPAY error – non-numeric data in full days	S	T
33730	MSPPAY error – non-numeric data in the total Medicare reimbursement	S	T
33740	MSPPAY error – PPS indicator not equal to “Y’ or “N”	S	T
33750	MSPPAY error – non-numeric data in the DRG amount	S	T
33760	MSPPAY error – non-numeric data in the indirect teaching adjustment	S	T
33770	MSPPAY error – non-numeric data in the pass- through per diem rate	S	T
33780	MSPPAY error – non-numeric data in the provider reimbursement amount	S	T
33790	MSPPAY error – non-numeric data in the patient payment amount	S	T
33820	MSPPAY error – non-numeric data in the charges not subject to deductible or coinsurance	S	T
33830	MSPPAY error – non-numeric data in the charges subject to deductible but not coinsurance	S	T
33860	MSPPAY error – invalid from date	S	T
33880	MSPPAY error – invalid through date	S	T
33970	MSPPAY error – non-numeric data in the outlier amount	S	T
34010	MSP primary claim submitted with positive auto record on file	T	R
34020	MSP primary claim submitted with positive Black Lung record on file	A	R
34023	MSP primary claim submitted with positive disability record on file	T	R
34025	Medicare is secondary – insurer unknown	S	R
34026	MSP primary claim submitted with positive PHS/ federal agency record on file	T	R
34031	Medicare is secondary - insurer unknown	S	R
34036	MSP primary claim submitted with positive liability record on file	T	R
34037	MSP primary claim submitted with positive liability record on file – insurer unknown	T	R
34039	MSP primary claim submitted with positive liability record on file – occurrence 05 on claim	T	R
34072	MSP primary claim submitted with positive working age record on file – occurrence 18 on claim	T	R
34073	MSP primary claim submitted with positive working age record on file – occurrence 19 on claim	T	R
34077	MSP primary claim submitted with positive ESRD record on file – bene age > 65 & DOS < 08/10/1993	S	R
34078	MSP ESRD record on file without term date	S	R
34079	MSP primary claim submitted with positive workers compensation record on file - 11115	S	R
34080	MSP primary claim submitted with positive workers compensation record on file -11116	S	R
34081	MSP primary claim submitted with positive workers compensation record on file -11117	S	R
34082	MSP primary claim submitted with positive workers compensation record on file -11118	S	R
34083	MSP primary claim submitted with positive liability record on file -11115	S	R
34084	MSP primary claim submitted with positive liability record on file -11116	S	R
34085	MSP primary claim submitted with positive liability record on file -11117	S	R
34086	MSP primary claim submitted with positive liability record on file -11118	S	R
34087	MSP primary claim submitted with positive Auto/no fault record on file -11115	S	R
34088	MSP primary claim submitted with positive Auto/no fault record on file -11116	S	R
34089	MSP primary claim submitted with positive Auto/no fault record on file -11117	S	R
34090	MSP primary claim submitted with positive Auto/no fault record on file -11118	S	T
34095	MSP primary claim submitted with positive ESRD record on file -11115	S	R
34096	MSP primary claim submitted with positive ESRD record on file -11116	S	R
34097	MSP primary claim submitted with positive ESRD record on file -11117	S	R
34098	MSP primary claim submitted with positive ESRD record on file -11118	S	R
34099	MSP primary claim submitted with positive disability record on file -11115	S	R
34100	MSP primary claim submitted with positive disability record on file -11116	S	R
34101	MSP primary claim submitted with positive disability record on file -11117	S	R
34102	MSP primary claim submitted with positive disability record on file -11118	S	R
34103	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11115)	S	R
34104	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11116)	S	R
34105	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11117)	S	R
34106	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11118)	S	R
34107	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11115)	S	R
34108	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11116)	S	R
34109	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11117)	S	R
34110	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11118)	S	R
34111	MSP primary claim submitted with positive PHS/ federal agency record on file (11115)	S	R
34112	MSP primary claim submitted with positive PHS/ federal agency record on file (11116)	S	R
34113	MSP primary claim submitted with positive PHS/ federal agency record on file (11117)	S	R
34114	MSP primary claim submitted with positive PHS/ federal agency record on file (11118)	S	R
34115	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11115)	S	R
34116	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11116)	S	R
34117	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11117)	S	R
34118	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11118)	S	R
34123	MSP primary claim submitted with positive Veterans record on file (11115)	S	T
34124	MSP primary claim submitted with positive Veterans record on file (11116)	S	T
34125	MSP primary claim submitted with positive Veterans record on file (11117)	S	T
34126	MSP primary claim submitted with positive Veterans record on file (11118)	S	T
34151	MSP primary claim submitted with positive ESRD record on file (55555)	S	R
34162	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (55555)	S	R
34163	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (55555)	S	R
34164	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (55555)	S	R
34251	MSP primary claim submitted with positive ESRD record on file (33333)	S	R
34262	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (33333)	S	R
34263	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (33333)	S	R
34264	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (33333)	S	R
34268	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11107)	S	R
34269	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11107)	S	R
34270	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11107)	S	R
34273	MSP primary claim submitted with positive PHS/ federal agency record on file (11107)	S	R
34275	MSP primary claim submitted with positive Veterans record on file (11107)	R	T
34291	MSP primary claim submitted with positive Veterans record on file (11109)	R	S
34308	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11111)	S	R
34309	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11111)	S	R
34370	MSP primary claim submitted with positive liability record on file (99999)	R	S
34468	MSP primary claim submitted with positive Working aged record on file (IEQ)	T	R
34469	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11101)	T	R
34470	MSP primary claim submitted with positive liability record on file – statement from date is at least 7 days > prepaid health plan date (11101)	T	R
34474	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11102)	T	R
34475	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11102)	T	R
34482	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11103)	T	R
34486	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11104)	T	R
34487	MSP primary claim submitted with positive ESRD record on file – statement from date is at least 7 days > prepaid health plan date (11104)	T	R
34488	MSP primary claim submitted with positive disability record on file – statement from date is at least 7 days > prepaid health plan date (11104)	T	R
34492	MSP primary claim submitted with positive working aged record on file – statement from date is at least 7 days > prepaid health plan date (11105)	T	R
34526	MSP primary claim submitted with positive working aged record on file (11125)	T	R
34527	MSP primary claim submitted with positive working aged record on file (11126)	T	R
34530	MSP primary claim submitted with positive disability record on file (11125)	T	R
38036	Medicare Secondary Payer duplicate	S	T
38062	Medicare Secondary Payer duplicate	S	R

J12 MAC Transition(* = off-site link)

J12 MAC Transition
(* = off-site link)