Edit 953

 Issue: Medicare needs to pay first before Medicaid. Resolution steps

Identify your specific issue:

Did you choose the correct 3-character carrier code?

• Enter the 3-character carrier code in field 9d on the CMS-1500. See how.
• The Medicare Part B carrier code is "620."
• Medicare supplement plans may have a different carrier code.
• See Appendix 2 Carrier Code Listing which includes company name, address, and contact information.

Did your clearinghouse translate your 3-character carrier code into a 5-character code?

• The clearinghouse may be altering your carrier code, causing the claim denial. Check with your clearinghouse or contact the Electronic Data Interchange (EDI) Support Center for assistance at: 1 (888) 289-0709.

Did you only attach the other insurance's EOB with the Medicaid claim?

• Attaching the EOB will not resolve this denial. You must also enter the correct Medicaid claim data on the claim. CMS-1500 example, UB claim example.

Did you line up the policy number, carrier code, and payment amount correctly on the UB claim?

• For UB claims: Ensure that corresponding data is on the same line: A, B, or C. If the carrier code is on line A of field 50, the policy number should also be on line A (not B or C) of field 60. UB claim example.

Did you indicate a third party payer on the claim?

• Ensure that the primary insurer's payment is entered correctly.
• If the primary insurer denied payment, you must enter 0.00 and indicate TPL denial.
  • CMS-1500: field 9c or 11b; TPL denial indicator "1" in field 10d CMS-1500 example
  • UB claim: field 54 UB claim example
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