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Edit 150

Issue: Claim needs to be filed to another insurance payer before Medicaid. Resolution steps

Identify your specific issue:

Did you enter the correct 3-character carrier code?

Did you enter the correct policy number?

  • The policy holder's number may differ from their dependent's. For instance, a dependent's policy number may include a suffix.

Does the patient no longer carry that primary insurance?

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

Did you mix and match the data between fields 9 and 11 on the CMS-1500? 

  • Make sure that the policy number, payment amount and carrier code for primary insurance(s) are entered in either field 9 (9a, 9c, 9d) or field 11 (11, 11b, 11c). For example, do not put the policy number in field 11 and then separate the payment amount and carrier code in field(s) 9c and 9d. CMS-1500 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.

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Last modified: Tuesday, April 26, 2016, 2:52 PM