31337

Reason Code Narrative
One of the following conditions has occurred:

  1. A value code 41 is present and payer ID 1 is not equal to H or C.
  2. A value code 42 is present and payer ID 1 is not equal to I or C.
  3. A value code 43 is present and payer ID 1 is not equal to G or C.

Common Reason Code Errors

  • A claim is billed as a Medicare Secondary Payer (MSP); however, more than one MSP value code is present
  • A claim contain both a Working Aged (12) value code and a Disabled (43) value code
  • A claim was submitted listing an insurance primary to Medicare; however, no value code is present for type of MSP or incorrect value code is present for type of insurance

Common Reason Code Corrections

  • Resubmit claim using the correct MSP value code for beneficiary's insurance

NOTE: Beneficiaries 65 years or older are eligible for Working Aged coverage. Beneficiaries younger than 65 years old are eligible for Disabled coverage.

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

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