.The following is information about correcting Medicare Secondary Claims that have been denied with a Reason Code MA04
From Medicare/TrailblazerHealth
Details for Reason Code MA04
Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or illegible.
Effective December 1, 2009, Medicare began closely editing claims submitted as Medicare Secondary Payer (MSP). The edit looks at the submitted MSP claim versus the Common Working File (CWF), which houses the Medicare beneficiary’s profile. If the claim has conflicting information, the claim will reject and must be refiled correctly in order to be processed.
Examples of this rejection:
The CWF records reflect Medicare is secondary payer to a disability
record (MSP type 43) and the insurance belongs to the patient’s
working spouse. The claim was submitted indicating working age (MSP
type 12) and that the insured is the spouse.
The claim
conflict: CWF reflects disability and the claim indicates working
aged. The claim will need to be corrected and refiled in order for
Medicare to consider for payment.
The CWF records reflect Medicare is the primary payer. The claim was submitted indicating “other liability” (MSP type 47); however, the claim did not indicate the date of the accident and the diagnosis codes on the claim did not appear to be related to an accident. The diagnosis codes indicated the patient was diabetic and hypertensive.
The claim conflict: CWF reflects Medicare is primary and no liability record is on file; however, the claim indicated the patient had been in an “other liability” accident but did not include the accident date or diagnosis codes representative of an accident. The claim will need to be corrected and refiled in order for Medicare to consider for payment.
Patient screening by office staff is now more important than ever to submit claims to Medicare correctly. Providers can refer to the MSP and Patient Screening/Registration manual for tips to enhance existing patient screening processes. The manual also includes detailed billing information for MSP claims. The manual can be found on the TrailBlazer Web site at: Medicare Secondary Payer Manual
MSP Instructions Updated 01/2010
TrailBlazer is experiencing an increased number of provider inquiries in the Provider Contact Center (PCC) regarding electronic claims that rejected for the Medicare Secondary Payer (MSP) type being missing or incorrect.
Providers are reminded that a code identifying the type of insurance policy within a specific insurance program is required on electronic claims when the destination payer is Medicare and Medicare is not the primary payer. The insurance type code should be submitted in the 2000B SBR05 loop/segment.
The Interactive Voice Response (IVR) provides the patient’s MSP type when selecting option 3 from the Eligibility Menu.
Examples:
12 Working-Aged
13 End Stage Renal Disease (ESRD)
14 Auto/Med/No-Fault Liability
15 Workers’ Compensation
41 Federal Black Lung
42 Veterans Affairs
43 Disability
47 Other Liability
Additional MSP billing information
can be found in the Medicare
Secondary Payer (MSP) manual .
Medicare Interactive tool for Medicare as secondary payer.
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14003
What to do in Medisoft
Edit the Patient's Case,
On the EDI tab, if the Insurance Type Code field is 0 then replace it with 43. Mark the claim Ready To Send and send it.