Edits
The MSP Department works edits daily.
If you find that an edit has been pending more than 45 days, please call 1-866-518-3284.
Helpful Tips for handling reason codes
- Verify the insurance name on CWF prior to submitting the claim and make sure the claim then indicates the correct insurance name to eliminate the return to your office to be corrected. If the insurance coverage has changed contact COBC at 1-800-999-1118 to be updated prior to resubmitting the claim. The insurance name must match CWF for the claim to process without manual intervention.
- Ensure you are using the correct value code with the correct Medicare entitlement for the patient prior to submitting the claim. If there is not an open record for the type of value code on the claim make sure to contact COBC at 1-800-999-1118 prior to submitting the claim.
- Ensure the appropriate "D" condition code is indicated on the electronic adjustments when they are submitted for processing.
-D7 - Medicare Secondary (MSP value code with amount higher than zero dollar amount)
-D8 - Medicare Primary
-D9 - Conditional Payment request (MSP value code with zero dollar amount) - For conditional payment claims processing ensure the following information is on the claim prior to submission:
-MSP value code with zero dollar amount
-24 occurrence code with date of denial or for no-fault (value code 14) or liability (value code 47) there must be occurrence code 01, 02 or 03 present on the claim
-For Workers Compensation (value code 15) occurrence code 04 and 24 must be present on the claim
-The payer code must be a "C" with the insurance name that is indicated on CWF unless it is incorrect then contact COBC at 1-800-999-1118 prior to submitting the claim
-Make sure to include remarks to explain the reason you are requesting a conditional payment
Page Last Updated: Monday, 09-Jun-2008 13:18:40 CDT
