FISS Narrative:

  • Value code 12 through 16 and 41 through 43 and 47 for Medicare Secondary Payer data must not contain any reference to 'Medicare' in line 'A' of item 50
  • Note the fourth digit of the reason code reflects the value code occurrence in which the error occurred. The sequence is 1-0 (0 denotes the tenth occurrence) and A-Z (Z denotes the 36th occurrence).

Explanation and Suggestion:

  • The only scenario where 'Medicare' would be entered into line A of Form Locator (FL) 50 is if Medicare is considered to be the primary payer
  • If Medicare is the secondary payer for your claim, enter 'Medicare' into Line B
  • The primary payer should be listed on line 'A' and the applicable MSP Value Code (Value Code 12-16, 41-43, or 47) and the corresponding amount should be listed in FL 39-41

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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Jurisdiction J Part A MAC

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Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC


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