All
providers should ensure
that their billing staffs
are aware of these changes.
Modification
to CWF, FISS, MCS and
VMS to Return Submitted
Information When There
is a CWF Name and HIC
Number Mismatch
MLN
Matters® Number: MM7260
Related
Change Request (CR) #:
CR 7260
Effective
Date: October 1, 2012
If
Medicare systems reject
a claim when the beneficiary
name does not match the
Health Insurance Claim
Number (HICN), your Medicare
contractor will return
the claim to you as unprocessable
with the identifying beneficiary
information from the submitted
claim as follows:
*
Your contractor will return
as unprocessable Part
B claims. Your contractor
will use Reason Code 140
(Patient/Insured health
identification number
and name do not match).
When
returning these claims
as unprocessable, your
contractor will utilize
remittance advice codes
MA130. Also, based on
CR 7260, you will receive
the beneficiary name information
you originally submitted
when the claim is returned
rather than the beneficiary
data associated with the
potentially incorrectly
entered HICN. Previously,
Medicare returned the
name of the beneficiary
that is associated with
that HICN within its files.
The
official instruction,
Change Request 7260 may
be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2449CP.pdf
on
the lefts for Medicare
& Medicaid Services
(CMS) website.
Please
Provide Patients with
Correct Medicare Contact
Information
Questions related to
Medicare services shall
be communicated through
the existing lefts for
Medicare & Medicaid
Services' resources, identified
below. Additional
information and assistance
can also be found at the
www.medicare.gov
Web site.
People
with Medicare shall contact
the telephone numbers
listed below for specific
Medicare questions.
Contact Information:
•
Medicare Service
left: 800-MEDICARE (800-633-4227)
•
Medicare Service
left TTY: 877-486-2048
•
Report Medicare
Fraud & Abuse: 800-HHS-TIPS
(1-800-447-8477)
•
Social Security
Administration: 1-800-772-1213 |
