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Published Date:12/27/2018

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

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FISS Narrative
An adjustment is being submitted against a record in a post pay location. The Medicare Secondary Payer (MSP) record on the Common Working File (CWF) needs to be in a finalized status before making an adjustment. Please wait until the record on CWF is final and then refile your adjustment.

Explanation and Suggestion
Providers are required to determine whether Medicare is a primary or secondary payer for each admission of a Medicare beneficiary prior to submitting a claim to Medicare. Providers are also required to review the CWF prior to submitting a claim to Medicare.

In order for a claim to be processed as Medicare primary or secondary, the claim must coincide with the information on the CWF. When a claim is rejected due to conflicting information on the CWF, you must wait until the CWF is updated before submitting any additional claims for that beneficiary. Palmetto GBA is holding claims for up to 75 days for the CWF to be updated. Claims will be returned to the provider requesting the CWF review prior to resubmission. Once the record on the CWF is updated, the provider should submit the claim at that time.

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Last Updated: 12/27/2018

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