How to Appeal MA64 Denial: Our records indicate that we should be the secondary payer for this claim
Medicare's records indicate it should be the secondary payer, not the primary, for this claim. This guide explains what it means, why it happens, and exactly how to build a winning appeal.
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What Does MA64 Mean?
Medicare's records indicate it should be the secondary payer, not the primary, for this claim.
Commonly seen in:
Step-by-Step Appeal Guide for MA64
- 1
Verify the patient's coverage status on the exact date of service via the payer portal
- 2
Obtain an Explanation of Benefits (EOB) showing the specific eligibility issue
- 3
Contact the employer/group plan administrator to confirm enrollment records
- 4
If the issue is COB-related, obtain a denial from the alleged primary payer
- 5
Resubmit with corrected eligibility information and supporting documentation
Counter-Arguments to Use in Your Appeal
These are the strongest arguments medical billing professionals use to overturn MA64 denials.
Determine whether the Medicare Secondary Payer (MSP) situation applies
If the patient has employer group health coverage as the primary, bill the GHP first
If Medicare should truly be primary, provide MSP documentation to support
Use the BCRC portal to verify MSP records and correct if needed
Regulations and Guidelines to Cite
Citing specific regulations strengthens your appeal and demonstrates you know your rights.
Expert Tip for MA64 Appeals
Use the BCRC (1-855-798-2627) to verify and correct MSP records. Incorrect MSP records are common and can be corrected with proper documentation.
Frequently Asked Questions
What is a MA64 denial code?
Medicare's records indicate it should be the secondary payer, not the primary, for this claim.
Can I appeal a MA64 denial?
Yes. All insurance denials are appealable. Follow the step-by-step guide above and submit your appeal before the payer's deadline, typically 180 days from the denial date.
What documentation do I need to appeal MA64?
For a MA64 denial, you typically need: the original denial letter/EOB, clinical documentation supporting the service, any prior authorization records, and a cover letter citing the relevant regulations listed above. The specific documents depend on why the denial was issued.
How long does a MA64 appeal take?
Most payers are required to process standard appeals within 30–60 days. Expedited appeals (for urgent care) must be decided within 72 hours. Under ERISA, group health plans must provide an appeal decision within 60 days for pre-service and 60 days for post-service claims.
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