Claims billing education: Medicaid secondary billing errors

Please review your electronic claims submission procedures and ensure all claims are submitted with the correct Claims Filing Indicator Codes as outlined below. Accurate use of these codes is crucial for the correct adjudication and payment of claims.

We identified an issue with claims when Medicare or Commercial is the primary payer and Medicaid is secondary. Claims are processing incorrectly due to provider billing errors. According to the DMAS Technical Manual, the Claims Filing Indicator Code is a mandatory field.

For electronic claims submissions, consult the Commonwealth of Virginia’s encounter processing solution (EPS) claims submission rules, which include the following guidelines for 837 transactions. Adhering to these guidelines will prevent recoupments and claims processing errors.

Claims filing requirements:

• Loop 2320 (Other Subscriber Information):
• Is used to report payment/adjudication information.
• Must be repeated for each payer involved (including MCO entities).
• Loop 2330B: Identifies the Payer.
• Loop 2430: Contains detailed adjudication/payment information.
• SBR01 (Payer Responsibility Sequence Number):
• Indicates the order of claim adjudication when multiple payers are involved.
• Medicaid is always the payer of last resort:
• P = Primary, S = Secondary, T = Tertiary
• SBR09 (Filing Indicator Code):
• Mandatory to specify the carrier type:
• Example: “MB” for Medicare Part B
• “MC” for Medicaid (including MCOs)
• Loop 2430, SVD01 (Other Payer Primary Identifier):
• Must match the value in Loop 2330B, NM109 (Other Payer Primary Identifier) for complete adjudication information.
• Filing Indicator Requirements:
• When Medicaid is the primary payer, use Indicator MC = Medicaid/MCO.
• When Medicaid is the secondary payer, use: MA = Medicare A, MB = Medicare B, OF = Medicare D, or CI = Commercial Insurance.

Please refer to EPS Support | MES (virginia.gov) for further information.

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For additional support, visit the Contact Us section of our provider website for the appropriate contact.