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Top Claim Submission Errors for All Providers: Error 1461A

Reason for error: Your claim includes a value code (12 — 16 or 41 — 43) which indicates that Medicare is the secondary payer; however, the claim identifies Medicare as the primary payer.

Claims Processing Result: Return to Provider (RTP)

How to prevent/resolve:

  • If your services are not related to the MSP record for no-fault, liability, workers’ compensation, or black lung, (value code 14, 15, 41, or 47), submit the claim showing Medicare as the primary payer.  Ensure that your claim does not include any MSP value codes, or diagnosis codes that are related to the MSP situation. 
  • If the primary insurance denied payment or applied the payment towards the beneficiary’s deductible, report the appropriate value code with a zero dollar amount.  The Payer/Payer Code field should reflect the primary insurer on line A, and Medicare on line B as the secondary payer.

For assistance in submitting Medicare Secondary Payer claims, refer to the following resources.

Posted: 10.10.13

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