General

1. How do I bill my Medicare Secondary Payer (MSP) claims to Medicare when the MSP insurance has denied payment? What justification do I need in the remarks section of the claim?
2. My claim rejected stating the patient has other insurance primary to Medicare. I checked the common working file (CWF) and have verified that the patient's file has been updated to show Medicare is primary. Why does my claim reject as a duplicate when I resubmit?
3. My patient has an open liability or no-fault file but the services we provided were not related to the accident. We billed Medicare but now our claim keeps cycling and will not finalize. What do I need to do to receive payment for these services?
4. Our patient advised us they have other insurance primary to Medicare. When I billed my claim, it was sent to the RTP file with reason code U6802 stating there is no direct match on the MSP auxiliary record at CWF. What do I need to do to get this claim processed?

1. How do I bill my Medicare Secondary Payer (MSP) claims to Medicare when the MSP insurance has denied payment? What justification do I need in the remarks section of the claim?

   When a patient's primary insurance denies payment, Medicare is billed conditionally. Occurrence code 24 is used with the date of the primary insurer's denial. Also, the appropriate value code will be used reflecting a payment of $0.00. Justification should be included in the remarks section of the claim per the Highmark Medicare Services Conditional MSP Claim Reference.  This reference may also assist with any additional MSP billing inquiries.

   (Question based on November 2008 top written inquiries)

   Date Posted: 12/16/2008

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2. My claim rejected stating the patient has other insurance primary to Medicare. I checked the common working file (CWF) and have verified that the patient's file has been updated to show Medicare is primary. Why does my claim reject as a duplicate when I resubmit?

   Your original claim which rejected for MSP has posted to the CWF.  When you resubmit a new claim, it will reject as a duplicate against the claim that is posted in the CWF.  In order for Medicare to consider the claim for payment, you must adjust the original rejected claim. 

   (Question based on September 2008 top phone inquiries)

   Date Posted: 10/15/2008, Date Reviewed/Revised: 12/16/2008

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3. My patient has an open liability or no-fault file but the services we provided were not related to the accident. We billed Medicare but now our claim keeps cycling and will not finalize. What do I need to do to receive payment for these services?

   When the beneficiary has an open liability or no-fault file, but the services provided are not related to the open files, providers should bill an occurrence code 05 with the service date of their claim.  This will ensure your claim does not continue to cycle due to the open MSP file.

   (Question based on October 2008 top telephone inquiries)

   Date Posted: 12/16/2008

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4. Our patient advised us they have other insurance primary to Medicare. When I billed my claim, it was sent to the RTP file with reason code U6802 stating there is no direct match on the MSP auxiliary record at CWF. What do I need to do to get this claim processed?

   If there is not an MSP auxiliary record at CWF, but your patient is stating there is other insurance primary to Medicare, your  patient needs to contact the Coordination of Benefits contractor (COB) to have an MSP file opened.  The patient can call the COB at 1-800-999-1118.

   (Question based on October 2008 top telephone inquiries)

   Date Posted: 12/16/2008

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