Medicare Secondary Payer (MSP) Reason Code 30928

How To Avoid
To avoid the claim RTPing with reason code 30928, providers are required to verify insurance and should verify what is on the Common Working File (CWF) prior to submitting the claim to determine if Medicare is primary or secondary to another insurance. If the CWF does not match what the beneficiary provided, work with the beneficiary to determine whether the claim information or the CWF needs to be corrected PRIOR to submitting the claim to Medicare for processing.

Important
If the claim is submitted and RTPs with reason code 30928, the claim will be required to stay in this status and location 75 days from the date the claim RTPs.

Scenario 1: If the CWF is incorrect, the provider must work with the beneficiary to ensure the CWF is updated, append the condition code, add remarks and resubmit the claim after 75 days.

  • Append condition code D9 and add remarks "CWF updated" if the claim is staying the same and the CWF was updated to match what was on the claim

Scenario 2: If the CWF is correct, the provider must correct the claim, add the correct condition code, add remarks and resubmit after 75 days.

  • Append condition code D7 and add remarks "changed to Medicare secondary" if the claim was billed as Medicare primary and is being changed to make Medicare secondary
  • Append condition code D8 and add remarks "changed to Medicare primary' "if the claim was billed as Medicare secondary to another insurance and is being changed to Medicare primary

Reference: CMS IOM Publication 100-05, Chapter 3, Section 20 (PDF, 234 KB).

 

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