Wiki I'm having trouble getting MSP claims paid. What exactly do I use for value codes?

[ljfreeman]

I have a question about MSP claims. What value code should I be using?

 

[SharonCollachi]

When you check Medicare for eligibility, and it comes up as MSP, it will tell you why the patient is MSP. Here is the table of codes, but be aware: even if the patient thinks they are type 12, but Medicare has them as type 43, for instance, your claim will deny. Most of the MSP I see are type 12 and type 43.

12	Working aged beneficiary/spouse with an EGHP (beneficiary over 65). Beneficiary must have Medicare Part A entitlement (enrolled in Part A) for this provision to apply. Primary Payer Code = A.
13	ESRD beneficiary with EGHP in MSP/ESRD 30-month coordination period. Primary Payer Code = B.
14	No-Fault including automobile/other. Examples: Personal injury protection (PIP) and medical payment coverage. Requires OC 01 or 02 with date of accident/injury. Primary Payer Code = D. If filing for a Conditional Payment, report with Occurrence Code 24.
15	Workers Compensation (WC). Requires CC 02 and OC 04 with date of accident/injury. Primary Payer Code = E. If filing for a Conditional Payment, report with Occurrence Code 24.
16	Public health services (PHS) or other federal agency. Conditional billing does not apply. Primary Payer Code = F.
41	Federal Black Lung (BL) Program. Primary Payer Code = H.
42	Veterans Administration (VA). Conditional billing does not apply. Primary Payer Code = I.
43	Disabled beneficiary under age 65 with an LGHP. Beneficiary must have Medicare Part A entitlement (enrolled in Part A) for this provision to apply. Primary Payer Code = G.
44	Amount provider was obligated/required to accept from a primary payer as payment in full due to contract/law when that amount is less than charges but higher than amount actually received. An MSP payment may be due. Note: When applicable, this VC is reported in addition to MSP VC.
47	Any Liability Insurance. Requires OC 02 with date of accident/injury. Primary Payer Code = L. If filing for a Conditional Payment, report with Occurrence Code 24.