Reason Code U6805

Description
GHP MSP conditional payment claim, but a GHP MSP record with a validity indicator equal to “I” or “Y” is not present for these dates of service.

Resolution
Contact the Medicare Secondary Payer (MSP) Contractor to update GHP file. Resubmit claim using 24 occurrence code for conditional payment. Check for common errors:

• A claim is billed for Medicare conditional payment; however, there are no valid Group Health Plan (GHP) files listed on the Common Working File (CWF)
• A claim is billed for Medicare conditional payment and there is a valid GHP file on CWF; however, the claim is missing 24 occurrence code

Note: GHP files are Working Aged (value code 12), Disabled (value code 43) and End Stage Renal Disease (ESRD) (value code 13).

Resources

• Medicare Secondary Payer (MSP) Contractor 
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Secondary Payer Manual, chapter 3 (PDF), section 30.2 - Provider Billing Where Services Are Accident Related and No-Fault Insurance May Be Available