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Printed Date: 9/22/2015
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.
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.
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.
Reference: CMS IOM Publication 100-05, Chapter 3, Section 20 (PDF, 234 KB).
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Last Updated: 03/28/2019