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Reason Code: 34072

Error Description:

The claim was submitted as Medicare primary and an open MSP Working Aged record (VC = 12; Payer Code = A) is in CWF. The claim contained information indicating the reason(s) Medicare is primary such as an OC 18 for the date of the beneficiary’s retirement and/or an OC 25 for the date benefits were terminated by the primary payer. However, that information is conflicting as follows:

  • OC 18 date is the same as or prior to the MSP record’s effective date or is the same as the claim “from” date. AND/OR
  • OC 25 date is either:
    • Prior to the claim DOS and not the same as the OC 18 date. Note: the beneficiary’s retirement date IS the EGHP end date if the beneficiary was covered by the EGHP through his/her own employer.
    • Within or after the claim DOS, and there is an MSP record indicating the spouse (not the beneficiary) is the policyholder. Note: the spouse’s retirement date (OC 19) IS the EGHP end date if the beneficiary was covered by the EGHP through his/her spouse’s employer.

Avoiding/Correcting This Error

Resolve all conflicting claim information:

  • If the claim has an OC 18 and date, verify the beneficiary’s retirement date. If the date is correct, add remarks to indicate the OC 18 date was verified and is correct.  If the date is not correct, enter the appropriate changes. If the beneficiary did not actually retire, remove the OC 18 and date.
  • If the claim has an OC 25 date, verify the date benefits were terminated by the primary payer and:
    • If you reported an OC 25 and date in addition to an OC 18 and date for the same reason (beneficiary retired and the EGHP benefits terminated), remove the OC 25 and date.
    • If you reported an OC 25 and date to indicate the spouse retired, add remarks to clarify that the OC 25 and date relates to the spouse’s MSP record. Important: for future claim submissions, do not report an OC 25 and date to indicate the spouse retired. Rather, report OC 19 and date for the spouse’s retirement date.
    • If you reported an OC 25 date because the primary payer terminated benefits for a reason other than retirement (of the beneficiary or the spouse), leave the OC 25 and date but add clarifying remarks to explain which primary payer you are referring to in the CWF, who the policyholder was (beneficiary or spouse) and what occurred that caused the primary payer’s benefits to terminate (for example, beneficiary or spouse left employment but did not retire).
  • Return your claim once it is corrected, as applicable
  • Note: The article on our website Prevent an MSP Rejection on a Medicare Primary Claim provides claim coding providers can use to indicate why Medicare is primary including CCs, OCs and dates and remarks. If there is no available claim coding to indicate the specific reason Medicare is primary, you may ask the beneficiary or other party to contact the BCRC using the contact information below, to request that the MSP record be corrected. Providers do not contact the BCRC for this reason. Return a corrected claim once the MSP record in the CWF is corrected.
  • BCRC contact information:
    • Telephone: 855-798-2627 or TTY/TTD: 855-797-2627 (for hearing and speech impaired), available Monday-Friday, 8:00 a.m. – 8:00 p.m. ET (except holidays).
    • Medicare-Data Collections, P.O. Box 138897, Oklahoma City, OK 73113-8897.

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