September 8, 2006
Other Payer ID Field 340-7C
OCC 3: “Other coverage exists—claim not covered.”
ISSUE: Claims are being submitted to PACE with an Other Coverage Code (OCC) of “3” and the required reject code, but in many instances the BIN submitted in the Other Payer ID Field is no longer valid. The claim is denied by the former (incorrect) payer resulting in PACE paying the claim.
OCC 4: “Other coverage exists-payment not collected.”
ISSUE: Claims are being submitted to PACE with an Other Coverage Code (OCC) of 4. Currently the Other Payer ID field – 340-7C may contain no BIN number, a discount card BIN or one that is no longer valid. Again, PACE pays the claim.
EFFECTIVE SEPTEMBER 19, 2006, to insure that the correct primary payer is being billed for those cardholders enrolled in one of the Department’s seven (7) partner plans, claims containing an OCC of 2, 3, 4, 5 or 7 must contain the valid BIN number of the primary payer in the Other Payer ID field – 340-7C. This BIN number will be compared to the BIN number on file. Non-matching BINs will reject with PACE Error 007; NCPDP Error 7C --- Missing/ Invalid Other Payer ID.
The correct payer and BIN will be returned in the Program’s response.
Questions should be directed to Provider Services at: