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Do I enter a qualifier in box 14 if patient has Medicare prime and secondary insurance?

November 12, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors 


<p>Recently a number of practices have inquired as to whether Medicare requires the three-digit qualifier to be populated in item/box 14 when submitting a claim. Item/box 14, <span style="text-decoration: underline;">Date of Current Illness, Injury, or Pregnancy (LMP)</span>, identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy, and contains a field allowing one of two qualifiers to be entered.</p>
<ul>
<li>431: Onset of Current Symptoms or Illness</li>
<li>484: Last Menstrual Period </li>
</ul>
<p>The <a href="http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf">Medicare Claims Processing Manual</a> advises that although space is included for a qualifier, Medicare does not use this information. However, many other payors <em>do</em> require the qualifier. So, in instances where Medicare is prime but the patient has a secondary insurance that requires population of the field, practices will need to include the information. Medicare has advised that while it does not require qualifier information, if needed for a secondary payor, Medicare will ignore the qualifier and the claims will be forwarded to the secondary payor through the coordination of benefits contractor for payment.</p>

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