Remark code MA83 is an indication that the billing party failed to specify whether the payer being billed is the primary or secondary insurance provider for the patient's claim. This information is essential for the payer to determine their responsibility for payment in relation to other payers.
Common causes of code MA83 are:
1. Incomplete or missing information on the claim form regarding the coordination of benefits when multiple payers are involved.
2. Failure to specify the order of responsibility when the patient has coverage from more than one insurance plan, such as primary, secondary, or tertiary insurance.
3. Incorrectly processed claims due to assumptions made by the billing staff about the primary payer without verification.
4. Lack of communication between the healthcare provider and the insurance companies to determine which one is the primary payer before submitting the claim.
5. The electronic claim submission system may have defaulted to a particular payer as primary without considering other insurance policies the patient holds.
6. Patient information on file may be outdated or incorrect, leading to confusion about the current primary insurance provider.
7. The payer receiving the claim may not have access to the necessary coordination of benefits information to determine their responsibility in the payment hierarchy.
Ways to mitigate code MA83 include ensuring that the patient's insurance information is accurately and completely recorded at the time of registration. This should include verifying the order of payers when a patient has multiple insurance plans. Implement a double-check system where the primary and secondary payers are confirmed before claims submission. Additionally, staff training on payer coordination benefits and proper claim form completion can help prevent this code from occurring. Use electronic verification systems when available to automatically determine the payer hierarchy and reduce manual errors.
The steps to address code MA83 involve reviewing the patient's insurance information to determine the coordination of benefits. Ensure that the primary payer has been correctly identified and that the claim has been submitted to them first. If the primary payer has processed the claim, include their Explanation of Benefits (EOB) when resubmitting the claim to the secondary payer. If the primary payer has not yet been billed, submit the claim to them immediately and adjust the billing records to reflect the correct payer sequence. Update the patient's file to prevent future occurrences and resubmit the claim with the appropriate payer designated as primary or secondary, as applicable.