Reason Code: 34538
Error Description:
The claim was submitted as Medicare primary but an open MSP Working Aged record (VC = 12; Payer Code = A) is in CWF and the claim did not contain the reason Medicare is primary (such as a retirement date).
Avoiding/Correcting This Error
- To avoid this error:
- When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim.
- To correct this error:
- If the MSP record is correct, submit the claim to the primary EGHP. Once you receive payment, submit the claim to the primary EGHP. Once you receive payment, submit an adjustment (TOB XX7) to this rejected claim to change it to an MSP claim (or a conditional claim, depending on the primary payer's response).
- If the MSP record is incorrect and Medicare is primary, submit an adjustment (TOB XX7) to this rejected claim to change it to Medicare primary as you billed originally. However, on the adjustment, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim.
- Note: Only if there is no claim coding available to report on the adjustment the 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. Submit your adjustment claim once the MSP record in the CWF is corrected.
- Do not resubmit claims rejected for 34538 as they will reject as duplicates.
- 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.
- Fax: 405-869-3307