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Last Modified: 11/10/2022 Location: FL, PR, USVI Business: Part A

Reject reason code 34538 FAQ

Q: We are receiving reject reason code 34538, so what steps can we take to avoid this reason code?
You can refer to Part A reason code lookup for a description associated with the Medicare Part A reason code. Enter a valid reason code into the box and click the submit button.
A: You receive this reason code when the beneficiary or the spouse was or is working for the date(s) of service and the employer’s insurance is primary to Medicare.
Upon patient registration and prior to submitting the claim, ask the beneficiary to complete the Medicare secondary payer (MSP) questionnaire external pdf file located in the CMS MSP IOM, Pub. 100-05, chapter 3, section 20.1.2.
There are several ways to confirm beneficiary eligibility:
Users can access eligibility information via direct data entry (DDE) pdf file.
Contact the interactive voice response (IVR) pdf file system by calling (877) 602-8816.
Note: Customer service representatives cannot assist you with eligibility information and are required by CMS to refer you to the IVR.
Obtain the beneficiary’s eligibility via the SPOT.
If the information is invalid
The provider or the beneficiary must contact the MSP Contractor external link at 1-855-798-2627, to have the record updated. Once the record is updated, refile the claim to Medicare for primary payment consideration.
If the information is valid
File the claim to the primary insurance listed on the beneficiary’s records and then to Medicare for secondary payment consideration
Avoiding MSP claim rejects
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.