Remark code MA64 indicates a claim's processing is on hold until primary and secondary payer details are provided to determine third payer responsibility.
Remark code MA64 indicates that the payer has determined they are the tertiary insurer for the submitted claim. Before they can proceed with processing, they require evidence of payment or denial from both the primary and secondary insurers. The healthcare provider must submit the Explanation of Benefits (EOB) or equivalent documentation from the other payers to facilitate further action on this claim.
Common causes of code MA64 are:
1. Incorrect or incomplete coordination of benefits (COB) information on the claim, leading to confusion about the order of payers.
2. Failure to submit the claim to the primary and secondary insurers before billing the tertiary insurer.
3. The primary or secondary payer has not processed the claim, or there is a delay in their payment, which needs to be resolved before the third payer can take action.
4. Incorrectly assuming the order of responsibility without verifying the patient's current coverage and benefits.
5. Lack of communication between the healthcare provider and the insurance companies, resulting in missing or unreported payments from other payers.
6. The claim was submitted to all payers simultaneously, rather than sequentially, causing the tertiary payer to request prior payment evidence.
7. The patient may have updated their insurance information, but the provider's records were not updated accordingly, leading to confusion about the correct order of payers.
8. Administrative errors, such as not attaching Explanation of Benefits (EOB) from the primary and secondary payers when submitting the claim to the tertiary payer.
Ways to mitigate code MA64 include ensuring that the patient's insurance information is accurate and up-to-date at the time of service. Before submitting a claim, verify the patient's coverage and benefits, including the coordination of benefits, to determine the correct order of payers. It's essential to submit claims to the primary and secondary payers first and wait for their Explanation of Benefits (EOB) or remittance advice before billing the tertiary insurer. Keep detailed records of all payments and responses from other payers, and include this information when submitting the claim to the tertiary insurer to avoid delays in processing and payment.
The steps to address code MA64 involve first verifying the accuracy of the insurance coordination of benefits. If the information is correct, obtain the Explanation of Benefits (EOB) or remittance advice from both the primary and secondary payers. Ensure that these documents reflect the payment details and any contractual adjustments. Then, resubmit the claim to the tertiary insurer with the EOBs from the primary and secondary payers attached, clearly indicating the payments and adjustments made by each. If the coordination of benefits information is incorrect, update the patient's insurance information in your billing system and coordinate with the correct primary and secondary payers to process the claim accordingly.
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