General

1. How do I correct my claim when Medicare initially paid as primary, but we have now been advised that there is other insurance that should have paid as primary?
2. My claim rejected stating the patient has other insurance primary to Medicare. I checked the common working file (CWF) and have verified that the patient's file has been updated to show Medicare is primary. Why does my claim reject as a duplicate when I resubmit?

1. How do I correct my claim when Medicare initially paid as primary, but we have now been advised that there is other insurance that should have paid as primary?

   You would need to submit an adjustment to the original paid claim making Medicare secondary, using condition code D7.  You should use the appropriate value code and payer code based on the type of primary insurance.  The Outreach and Education department at Highmark Medicare Services will be holding numerous MSP workshop trainings in October.  Please check the Part A events page to sign up.

   (Question based on August 2008 top written inquiries)

   Date Posted: 10/15/2008, Date Reviewed/Revised: 10/29/2008

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2. My claim rejected stating the patient has other insurance primary to Medicare. I checked the common working file (CWF) and have verified that the patient's file has been updated to show Medicare is primary. Why does my claim reject as a duplicate when I resubmit?

   Your original claim which rejected for MSP has posted to the CWF.  When you resubmit a new claim, it will reject as a duplicate against the claim that is posted in the CWF.  In order for Medicare to consider the claim for payment, you must adjust the original rejected claim. 

   (Question based on August & September 2008 top phone inquiries)

   Date Posted: 10/15/2008, Date Reviewed/Revised: 10/29/2008

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