Reason Code U6825

Description
Non-GHP 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-Group Health Plan (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).

Contact Benefits Coordination and Recovery Center (BCRC) to update Non-GHP file(s). Resubmit claim using 24 occurrence code for conditional payment.

Resources

  • Benefits Coordination & Recovery Center (BCRC) 
  • CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, chapter 5 (PDF, 234 KB), section 3, 30.2 — Provider Billing Where Services Are Accident Related and No-Fault Insurance May Be Available