CMS Pub. 100-05, ch. 6, § 40.8

CWF

(Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23)

Error

Code Error Description Resolution

6801 GHP MSP indicated on claim - no

MSP auxiliary record exists on CWF

data base.

Prepare an "I" MSP maintenance

transaction and resubmit claim to

CWF. See §10.1 for criteria to submit

"I". If "I" criteria is not met, submit an

MSP inquiry via ECRS.

Error

Code Error Description Resolution

6802 GHP MSP indicated on claim - no

match on MSP auxiliary file.

(1) Analyze CWF auxiliary file.

(2) Create a new "I" MSP auxiliary

record, or if "I" record criteria is not

met, submit an MSP inquiry or CWF

assistance request via ECRS; and

(3) Resubmit claim.

NOTE: Match criteria: MSP types are equal, validity indicator equals "Y," dates of

service are within MSP period and NO override code is indicated on claim.

6803 GHP MSP auxiliary record exists - no

GHP MSP indicated on claim but dates

of service match a GHP occurrence.

(1) Deny claim. Advise

beneficiary/provider: "Resubmit

claim with other payer's Explanation

of Benefits for possible secondary

payment. If other insurance has

terminated, resubmit with

documentation showing termination

dates of other insurance." If you have

documentation showing termination

of the insurance coverage indicated in

the CWF, MSP occurrence, process

as follows:

(2) Post a termination date; or

(3) Resubmit claim as MSP.

If the termination date is incorrect,

submit a CWF assistance request via

ECRS.

6805 GHP MSP conditional payment claim

and matching MSP record with “I”or

"Y" validity indicator not found for

these dates of service.

(1) A/ B MACs only: Create an "I"

MSP Auxiliary Record when it fits

the criteria for adding an "I" record.

(2) Submit MSP inquiry or CWF

assistance request via ECRS.

(3) Resubmit claim.

6806 MSP override code equals "M" and no

GHP MSP record found with

overlapping dates of service.

If record was deleted in error, request

CWF assistance request. Do not

recreate record with "I" validity

indicator.

6810 Part A claim was processed and only a Part B (Insurer type = "K") matching

record was found.

6811 Part B claim was processed and only a Part A (Insurer type = "J") matching

record was found.

6815 WC Medicare Set-Aside exists (Insurer type= “W”). Medicare contractor

payment not allowed.

Error

Code Error Description Resolution

6816 No-Fault over-rideable utilization error code to be used when a valid (Y)

ORM indicator is on the MSP CWF auxiliary file and the diagnosis codes on

the claim match the diagnosis codes (or match within the family of diagnosis

codes) on the open MSP ORM record on CWF. MACs shall deny the

claim(s) as a Medicare payment is not allowed.

6817 Workers’ Compensation over-rideable utilization error code to be used when

a valid (Y) ORM indicator is on the MSP CWF auxiliary file and the

diagnosis codes on the claim match the diagnosis codes (or match within the

family of diagnosis codes) on the open MSP ORM record on CWF. MACs

shall deny the claim(s) as a Medicare payment is not allowed.

6818 Liability over-rideable utilization error code to be used when a valid (Y)

ORM indicator is on the MSP CWF auxiliary file and the diagnosis codes on

the claim match the diagnosis codes (or match within the family of diagnosis

codes) on the open MSP ORM record on CWF. MACs shall deny the

claim(s) as a Medicare payment is not allowed.

6819 A non-GHP ('D', 'H' or 'L') MSP auxiliary record exists, and no non-GHP

MSP is indicated on the claim, but the Dates of Service match, the diagnosis

on the claim is a match within the family of diagnosis codes OR a non-GHP

('E') MSP auxiliary record exists, and no non-GHP MSP is indicated on the

claim, but the Dates of Service match, the diagnosis on the claim is an exact

match or a match within the family of diagnosis codes.

6821 Non-GHP MSP indicated on claim; no MSP Auxiliary file exists. This

indicates no Non-GHP MSP file found.

6822 Non-GHP MSP indicated on the claim; a Non-GHP match does not exist on

MSP Auxiliary file.

6823 Beneficiary has a non-GHP MSP Type record 'S' on the Auxiliary file; there is

a matching diagnosis on the claim and auxiliary file, and the claim contains

payment (full or conditional).

6824 Beneficiary has a non-GHP MSP Type record 'T' on the Auxiliary file; there is

a matching diagnosis on the claim and auxiliary file, and the claim contains

payment (full or conditional).

6825 Non-GHP MSP conditional payment claim, but a non-GHP MSP record with

a Validity Indicator equal to 'I' or 'Y' is not present for these Dates of Service.

6826 MSP Override Code is 'N' or Cost Avoid and no non-GHP MSP record is

found with overlapping Date of Service.

6830 Part A claim was processed and only a Part B (Insurer Type 'K') matching

non-GHP record was found.

6832 The non-GHP MSP occurrence ('D', 'E', 'H', 'L', 'S', 'T', or 'W') does not

contain a diagnosis code.

6833 The ICD-9 diagnosis on the claim is not an exact or Family match to the ICD-

10 diagnosis on the open non-GHP MSP Aux record (Value Code '14' (MSP

Codes 'D' or 'T'), Value Code '15' (MSP Codes 'E' or 'W'), Value Codes '47'

(MSP Codes 'L' or 'S'), or

the ICD-10 diagnosis on the claim is not an exact or Family match to the ICD-

9 diagnosis on the open non-GHP MSP Aux record (Value Code '14' (MSP

Codes 'D' or 'T'), Value Code '15' (MSP Codes 'E' or 'W'), Value Codes '47'

(MSP Codes 'L' or 'S').

6834 When the claim is secondary and it shows there is a GHP insurer, but the MSP

record on CWF has only a non-GHP MSP occurrence.

6835 When the claim is secondary and it shows there is a non-GHP insurer, but the

MSP record on CWF has only a GHP MSP occurrence.

See discussion in §40.4 above for proper use of override codes.