Reason Code U6805

Description
GHP MSP conditional payment claim, but a GHP MSP record with a validity indicator equal to “I” or “Y” is not present for these dates of service.

Resolution
Contact Benefits Coordination and Recovery Center (BCRC) to update GHP file. Resubmit claim using 24 occurrence code for conditional payment. Check for common errors:

  • A claim is billed for Medicare conditional payment; however, there are no valid Group Health Plan (GHP) files listed on the Common Working File (CWF)
  • A claim is billed for Medicare conditional payment and there is a valid GHP file on CWF; however, the claim is missing 24 occurrence code

Note: GHP files are Working Aged (value code 12), Disabled (value code 43) and End Stage Renal Disease (ESRD) (value code 13).

Resources

 

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

Other Palmetto GBA Sites

Palmetto GBA Home

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Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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