Why are my claims rejecting Medicare Secondary Payer (MSP) with Reason Code CO-16 and remarks codes MA04 and MA130 and what do I need to do?

Answer: There are two reasons your claim may have rejected. You must correct and resubmit the rejected claim with valid and necessary information for adjudication of your claim.

Reviewing the issues below will assist in resolving rejections with Remark Code MA04: "Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible."

  • Issue: Palmetto GBA will reject a claim when there was a mismatch between the MSP Type submitted on an electronic claim and the specific patient's Medicare record
    • Palmetto GBA has implemented new MSP messaging to assist providers in quickly identifying claims that have rejected for incorrect MSP type based on information Medicare has on file. The new messaging is effective for claims processed on and after February 27, 2019. You will see CARC P6 and RARC N541 for these situations.
    • Claim Adjustment Reason Code P6, Reason and Remark Code N541: Mismatch between the submitted insurance type code and the information stored in our system
  • Resolution:
  • Issue: When billing electronically, you must provide details regarding how the primary insurer handled the patient’s claim
  • Resolution:
    • The ASC v5010 format allows for electronic submission of primary payer information for MSP claims using the correct loops and segments
    • Review the Palmetto GBA article Electronic Submission of MSP Claims for proper claim submission of MSP payment information
    • Make any necessary corrections to the claim to provide the required information and resubmit the claim

Review the Palmetto GBA MSP Topic web page for additional MSP resources and the Washington Publishing Company website for Reason and Remark code descriptions.

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