Reason Code 31689

Published 12/29/2021

FISS Narrative
You have submitted a claim with receipt date on or after January 1, 2016, with one or more primary payers to Medicare and the value in the paid amount on Map 1719 does not match the dollar amount associated with one of the MSP Value Codes (12, 13, 14, 15, 41, 43 or 47) billed on your claim.

Explanation and Suggestion
The submitted claim is reporting Medicare as secondary or tertiary and the dollar amount entered in the paid amount field is not equal to the dollar amount entered for the MSP Value Code (12, 13, 14, 15, 41, 43 or 47).  You may view the Palmetto GBA DDE Training Modules (DDE Module: 3A MSP Claims) prior to correcting and resubmitting the claim.

Reference: CMS IOM Publication Number 100-05.

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