Corporate

July 30, 2013

Primary Insurance Information: Paper Claim Submission

Information about insurance primary to Medicare must be submitted on Medicare claims, including paper claims.  If the patient has insurance primary to Medicare, for paper claims, this information ("Insured's policy group or FECA number") must be entered in block 11 and the name of the insurer entered in Item 11c. If the patient does not have primary insurance, indicate "NONE" in Item 11, and no other action is necessary.

Effective immediately, paper claims that do not include this information (in Item 11 will be rejected as unprocessable with the following remark codes:

  • MA130:  Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
  • MA92:  Missing plan information for other insurance.
  • N245:  Incomplete/invalid plan information for other insurance.
  • MA83 - Did not indicate whether we are the primary or secondary payer.

Rejected claims do not have appeal rights.  Correct the claim to include the missing information and resubmit as a new claim.

Resources:

  • CMS-1500 Claim Form/American National Standards Institute (ANSI) Crosswalk Job Aid: http://www.cgsmedicare.com/pdf/5010_jobaid.pdfPDF
  • Instructions for completing the CMS-1500 claim form: CMS Medicare Claims Processing Manual (Pub.100-04), chapter 26
  • Administrative Simplification Compliance Act (ASCA) requirement to submit electronic claims, and exceptions to these requirements:
  • CMS Electronic Billing & EDI Transactions web page
  • CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 24, sections 90-90.6

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