Forum - Questions & Answers

May 27th, 2014 - kmccane

adjustment reason code

I have a patient that is MSP & I received a denial EOB from the primary insurance stating the patients policy benefits have been exhausted. I have to submit the claim to Medicare as the secondary payer electronically. I am unable to find the adjustment code for exhausted benefits and I do not know how to add the adjustment code to the primary payment/denial. Would you please help? Thank you.

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May 27th, 2014 - REGINA1975 10 

re: adjustment reason code

hi.
from my understanding as a biller, you will need to submit the primary eob to medicare, so medicare can process as primary. since the patient is medicare eligible and they no longer have primary coverage, medicare will be primary. usually you will have to follow medicare appeal guidelines. also, adjustment codes can be created manually depending on what software you use to post payments. hope that helps.

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May 27th, 2014 - LBAROGIANIS 250 

re: adjustment reason code

The code is co 119, make sure you send it to the msp address which is po box 44078 jacksonville fl. You can't send paper claims to them anymore and this works fine for us.. *** What is the name of your practice management? If it's something I am familar with I can help you add the code, if not, someone else reading this might have the same software..

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