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Last Modified: 1/6/2012
Location: FL, PR, USVI
Business: Part A
34538
Claim submitted as Medicare primary and a positive working elderly record exists at the common working file (CWF). The contractor ID is equal to '11121'. The claim should be billed to the employer group health plan (EGHP).
Resources/tips to avoid or correct this reject code
Prior to submitting your claims, verify if Medicare is primary or secondary. There are several ways to obtain this information:
• Have your patient complete the Medicare Secondary Payer (MSP) Questionnaire 
to help you determine if Medicare is primary or secondary.
to help you determine if Medicare is primary or secondary.• Ask the beneficiary if his or her spouse is currently working and/or has insurance through an employer.
• If the answer is yes, the claim must be submitted to the employer group health plan first.
• If the answer is no, the beneficiary and/or the provider will need to contact the Coordination of Benefits Contractor (COBC) at 1-800-999-1118 (Monday-Friday from 8:00 AM to 8:00 PM, ET) to have the file updated. Once the file is updated, the claim can be re-submitted to Medicare as primary.
• Direct data entry (DDE) 
users can access the beneficiary's eligibility information by using the ELGA (eligibility A) screen.
users can access the beneficiary's eligibility information by using the ELGA (eligibility A) screen.Review the Centers for Medicare & Medicaid Services (CMS) Internet-only manuals (IOM), Publication 100-05, Medicare Secondary Payer (MSP) manuals. Chapter 3 -- MSP Provider, Physician, and Other Supplier Billing Requirements 
, sections 30, 40, and 50.
, sections 30, 40, and 50.If Medicare secondary payer (MSP) records are correct, submit the claim to the primary insurance.
• Once payment information is received, perform an adjustment to the claim and resubmit.
• If there are multiple open MSP files, verify coverage from these entities as well before submitting your claim.
If you have information disputing the primary insurance on file, then the beneficiary and/or the provider will need to contact the Coordination of Benefits Contractor (COBC) at 1-800-999-1118 (Monday-Friday from 8:00 AM to 8:00 PM, ET) to have the file updated.
• Once the file is updated, the claim can be submitted to Medicare as primary.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
