15701

FISS Narrative
'Medicare' must be entered on one of the lines (a, b or c) in UB-04 field locator 50 depending on whether Medicare is the primary, secondary or tertiary payer. Please correct and resubmit/rekey. Hard copy submitters resubmit RTP Report with corrections.

Explanation and Suggestion
Payer identification is a required field. It is field locator 50 a, b and c on the UB-04 and must be placed on the claim.

(A) Primary Payer – If Medicare is the primary payer, enter 'Medicare' on line A. This indicates that Medicare is the primary payer. If there are payer(s) of higher priority than Medicare, enter the name of the higher priority payer on line A.

(B) Secondary Payer – If Medicare is the secondary payer, identify the primary payer on line A and enter 'Medicare' on line B.

(C) Tertiary Payer – If Medicare is the tertiary payer, identify the primary payer on line A, the secondary payer on line B and enter 'Medicare' on line C.

Please notify software vendors if necessary.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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