Reason Code: 34538
Error Description:
Hospice: Claim submitted as Medicare primary and a positive working elderly record exists at CWF. The claim should be billed to the primary insurer.
Avoiding/Correcting This Error
If this is correct: Follow MSP billing guidelines and submit the claim accordingly.
If this is incorrect: As part of a provider’s eligibility verification process for Medicare beneficiaries, which is required to be conducted before claims are submitted to Medicare, providers should be checking for MSP file(s) on CWF. If you have information that disputes open records - we are not the Medicare office that manages those files. Please contact the BCRC:
Monday‒Friday, 8:00 a.m.‒8:00 p.m. ET (except holidays)
- Telephone: 855-798-2627 or
- TTY/TDD: 855-797-2627 (for hearing and speech impaired)
Address for general MSP correspondence:
Medicare – MSP General Correspondence
P.O. Box 138897
Oklahoma City, OK 73113-8897
Fax: 405-869-3307
In addition, providers should utilize all available/applicable condition codes, occurrence codes and remarks opportunities when submitting Medicare primary claims when there is an active MSP file on CWF.