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Medicare News Update Medicare Information Resource
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MIR-2006-10A, October 2006
Electronic Medicare Secondary Payer (MSP) Claims Out of Balance
Effective with the 9/29/06 cycle date, Empire Medicare Services will be implementing a new edit and returning electronic Medicare Secondary Payer (MSP) claims that are out of balance. Any errored claim will be returned to the submitter on the MEDICARE PART A INBOUND REJECT REPORT (HB997ZRJ-A) with the following error messages:
- Primary Payer Claim Does Not Balance
- Secondary Payer Claim Does Not Balance
- Adjustment Reason Codes Missing/Invalid
The calculation performed for this edit is as follows.
From the 837 v4010A1 transaction set from Loop 2320:
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Total Submitted Charges |
(AMT segment with Qualifier T3) |
Minus |
Claim Adjustments |
(CAS segments- claim adjustments from both the claim level Loop 2320 and the line level Loop 2430 as applicable) |
Equal |
Payer Prior Payment |
(AMT segment with Qualifier C4) |
Claims that fail this edit will need to be corrected and electronically resubmitted.
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