Reason Code 30928

Published 12/16/2019

An adjustment is being processed against a record in a post pay location.

Providers are required to determine whether Medicare is a primary or secondary payer for each admission of a Medicare beneficiary prior to submitting a claim to Medicare. Providers are also required to review the CWF prior to submitting a claim to Medicare.

In order for a claim to be processed as Medicare primary or secondary, the claim must coincide with the information on the CWF. When a claim is rejected due to conflicting information on the CWF, you must wait until the CWF is updated before submitting any additional claims for that beneficiary. Palmetto GBA is holding claims for up to 75 days for the CWF to be updated. Claims will be returned to the provider requesting the CWF review prior to resubmission. Once the record on the CWF is updated, the provider should submit the claim at that time.

CMS Internet Only Manual (IOM), Publication 100-5, Medicare Secondary Payer (MSP) Manual, chapter 3 (PDF).



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