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Edit 953



 Issue: Medicare needs to pay first before MedicaidResolution steps

Identify your specific issue:

Did you choose the correct 3-character carrier code?

    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?

    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: Thursday, March 9, 2023, 4:11 PM