Skip to main content
Corporate

Billing MSP Claims With Value Code 44

Value code 44 is defined as the amount a provider agreed to accept from a primary insurer as payment in full. You may also see this referred to as "Obligated to Accept as Payment in Full, or OTAF.

Value code 44 should be submitted on MSP claims when the amount the provider agreed to accept is:

  • Less than the charges; and
  • Higher than the payment received from the primary insurer.

Value code 44 should not be submitted when billing conditionally, and:

  • The provider did not agree to accept a lesser amount than their charges from the primary payer as payment in full; or
  • Charges are equal to the amount the provider agreed to accept; or
  • Payment from the primary insurance is more than the amount they agreed to accept.

Example: A beneficiary has a working aged insurance (value code 12) where their deductible amount is $1000.00; however, none of the deductible has been met. The claim submitted has a total charge of $1600.00. These charges are subject to the deductible amount. The working aged insurance will only allow $1200.00, and the provider agrees to accept this as payment in full (value code 44). Since none of the deductible was met, the primary insurer applied the $1000.00 to the deductible and paid $200.00.

When submitting the claim to Medicare, the provider will report the following information, in addition to the other data as required by their type of bill (TOB).

UB-04 Form Locator (FL)

Code Entered

Date/Dollar Amount

Occurrence Code/Date
(FL 31-34)

24

Date on the explanation of benefits (EOB) received from the primary insurer.

(Note: Occurrence code 24 is only used when no payment ($0000.00) is received from the primary insurer.)

Value Code (FL 39-41)

12

$200.00

Value Code (FL 39-41)

44

$1200.00

For details about the data required to submit an MSP claim, refer to the CGS "Medicare Secondary Payer (MSP) Billing and AdjustmentsPDF" quick resource tool.

Posted: 02.05.19

Was this page helpful? YES NO


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved