Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
How To Avoid: To avoid the claim RTPing with reason code 30928, providers are required to verify insurance and should verify what is on the Common Working File (CWF) prior to submitting the claim to determine if Medicare is primary or secondary to another insurance. If the CWF does not match what the beneficiary provided, work with the beneficiary to determine whether the claim information or the CWF needs to be corrected PRIOR to submitting the claim to Medicare for processing.
Important: If the claim is submitted and RTPs with reason code 30928, the claim will be required to stay in this status and location 75 days from the date the claim RTPs.
Scenario 1: If the CWF is incorrect, the provider must work with the beneficiary to ensure the CWF is updated, append the condition code, add remarks and resubmit the claim after 75 days.
Scenario 2: If the CWF is correct, the provider must correct the claim, add the correct condition code, add remarks and resubmit after 75 days.
Reference: CMS IOM Publication 100-05, Chapter 3, Section 20 (PDF, 478 KB)
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 07/19/2018