31689

FISS Narrative
You have submitted a claim with receipt date on or after 1-1-2016 with one or more primary payers to Medicare and the value in the paid amount on Map 1719 does not match the dollar amount associated with one of the MSP Value Codes (12, 13, 14, 15, 41, 43, or 47) billed on your claim.

Explanation and Suggestion:
MLN Matters Article 8486 (PDF, 100 KB) - Instructions on Using the Claim Adjustment Segment (CAS) for Medicare Secondary Payer (MSP) Part A CMS-1450 Paper Claims, Direct Data Entry (DDE), and 837 Institutional Claims Transactions; implemented updates that impacts electronic MSP claims submission effective for claims received on or after January 1, 2016.             

The submitted claim is reporting Medicare as secondary or tertiary and the dollar amount entered in the paid amount field is not equal to the dollar amount entered for the MSP Value Code (12, 13, 14, 15, 41, 43 or 47).  You may view the Palmetto GBA DDE Training Modules (DDE Module: 3A MSP Claims) prior to correcting and resubmitting the claim.

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