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Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code 1461A

Description:

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.

Resolution:

  • 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.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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