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Printed Date: 9/22/2015
Medicare is secondary or tertiary and the dollar amount entered in the PD AMT field on MAP1719 (F11 on page 3) is not equal to the dollar amount entered for the MSP Value Code (12, 13, 14, 15, 41, 43 or 47).
Refer to MM8486 (PDF, 100 KB): Instructions on Utilizing 837 Institutional Claim Adjustment Segment (CAS) for Medicare Secondary Payer (MSP) Part A Claims in Direct Data Entry (DDE) and 837I 5010 Claims Transactions.
Check claim and correct amount entered on MAP1719 or the dollar amount entered for the MSP Value Code. F9 or resubmit claim.
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Last Updated: 12/16/2019