MSP Pre-Pass Edits on Electronic Claims
If you are receiving front end pre-pass errors on your electronic claim files that have an edit/error number of M384, M385 or M386 corrections need to be made before trying to resubmit the claims. These are errors on Medicare Secondary Payer claims.
M384 is the edit that will hit if the total submitted charge on the claim does not equal all of the adjustment amounts being submitted on the claim. For example, this means the amounts being supplied as the primary insurance paid amounts and adjusted amounts do not equal the billed amounts at the line level and/or claim level. If the claim lacks standard claim adjustment reason codes to identify adjustments this will cause the claim not to balance. Another issue that may cause a problem with the claim not balancing is the primary payer identified at the claim level 2330B NM109 and line level 2430 SVD01 MUST match in order for CAS segments to be included in the balancing of the claim.
M385 and M386 are editing because the adjustment reason codes being sent are not valid. This could be due to the dates of service on the claim and the effective date of the adjustment reason code. Correcting the adjustment reason code needs to be made before resubmitting the claim in question.
Information on sending MSP claims into Medicare and the requirements needed on the claims can be found in our June 2006 Communiqué in an article titled "Medicare Secondary Payer (MSP) Balancing Edit (CR 4261)."
If you have any questions, please contact the EDI Hotline for IL/MI/WI (877) 567-7261
For Minnesota, please contact (952) 885-2882, (952) 885-2881or (952) 885-2811
Page Last Updated: Monday, 09-Jun-2008 13:19:56 CDT
