Reason Code 31102
The claim is being submitted requesting conditional payment with a ”C” in line A of the payor field and does not meet the guidelines for conditional payment.
- MSP information should not be submitted on RAPs, regardless of any MSP records impacting your dates of service. When billing your RAP to Medicare, ensure that you indicate Medicare as the primary payer.
- Your claim is being returned for one of the following reasons:
- Remarks are required when billing conditional. Please add your comments to the remarks page of the claim, value code with no money, payer code ”C” and occurrence code 24 with date. CARC code information should not be included on a conditional request, only the date field and amount paid showing 0.00.
- Your claim contains a CARC code stating reason for denial from primary insurance. Claim should be submitted secondary not conditional. Please resubmit secondary with correct payer code (not “C”).
Note: when billing secondary, occurrence code 24 is not required. Also, if primary insurance is applied to deductible, coinsurance or copay, this is not conditional. You should bill Medicare secondary with appropriate CARC codes.
- For value code 14, 15 or 47 — If you have used the 120-day remark, you are confirming that you have billed the primary insurance and received notice that the case is still pending. However, if CWF shows a term date for the MSP record, you may not use the 120-day/litigation/pending remarks.
- Home health RAPs should not include MSP information and should be billed Medicare primary
- For value codes 14, 15 and 47 — If benefits are exhausted, contact the MSP Contractor at 855–798–2627 to have term date added to the record shown on CWF. Then bill Medicare primary with remarks that state "benefits exhausted."
- Condition code 08 is not a reason to request conditional payment. If unable to obtain MSP info from the beneficiary, please utilize an eligibility system to look up the beneficiary’s MSP status.
- With value codes 16, 41 and 42 — conditional payment should never be requested
- If the beneficiary received payment, please bill the beneficiary for these services