Reason Code 1461A

Published 10/02/2020

Your claim includes a value code (12–16 or 41–43) which indicates that Medicare is the secondary payer; however, the claim identifies Medicare as the primary payer.

If your services are not related to the MSP record for no-fault, liability, workers’ compensation or black lung, (value codes 14, 15, 41 or 47), submit the claim showing Medicare as the primary payer. Ensure that your claim does not include any MSP value codes, or diagnosis codes that are related to the MSP situation.

If the primary insurance denied payment or applied the payment towards the beneficiary’s deductible, report the appropriate value code with a zero-dollar amount. The Payer/Payer Code field should reflect the primary insurer on line A, and Medicare on line B as the secondary payer. Ensure the CARC received from the primary EOB is submitted on the claim. If the primary EOB does not include a CARC, please select the most appreciate code from the WPC list.

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