Electronic Medicare Secondary Payer (MSP) Submitters

Did you know that after a primary insurance carrier has processed your claim the office "must" include claim adjustment reason codes (CARC) when sending it to Medicare for processing?

As of June 1st you will no longer see code 42 being used:
Code 42: "Charges exceed our fee schedule or maximum allowable amount"

This code has been replaced with code 45:
code 45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement."

If you have not been using Code 45 since June 1st your claims maybe getting rejected by Medicare.

CARC codes are updated 3x's a year and can be viewed at: http://www.wpc-edi.com/custom_html/claimadjustment.htm

Please take a few minutes to review this website for additional information.

Confused by Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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