Reason Code U6825
Published 10/24/2023
Description
Non-Non-Group Health Plan (GHP) Medicare Secondary Payer (MSP) conditional payment claim, but a non-GHP MSP record with a validity indicator equal to “I” or “Y” is not present for these dates of service.
Resolution
Check for common errors:
- A claim is billed for Medicare conditional payment; however, there are no valid Non-GHP files listed on Common Working File (CWF)
- A claim is billed for Medicare conditional payment and there is a valid Non-GHP file on CWF; however, claim is missing 24 occurrence code
Note: Non-GHP files are also referred to as Third Party Liability (TPL) files. MSP TPL files are No-Fault (value code 14), Liability (value code 47), Workers' Compensation (value code 15) and Black Lung (value code 41).
Beneficiaries should contact the MSP Contractor to update Non-GHP file(s). Resubmit claim using 24 occurrence code for conditional payment.
Resources
- MSP Contractor
- CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 5 (PDF), section 3, 30.2 — Provider Billing Where Services Are Accident Related and No-Fault Insurance May Be Available