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.