Modification to CWF, FISS, MCS and VMS to Return Submitted Information When There is a CWF Name and HIC Number Mismatch

In a new transmittal, CMS says, it will roll back a policy it put in place Oct.1, 2012 that required the patient name associated with the health insurance claim number (HICN) to be an exact match with the beneficiary’s first initial and the first six letters of the last name (including special characters) as listed in Medicare’s Common Working File database for the claim to go through. Starting April 1, 2013 CMS will return to its pre-Oct. 1 policy, which was not so strict.

If Medicare systems reject a claim when there is a mismatch of the Health Insurance Claim Number (HICN) with the beneficiary’s personal characteristics (such as name, sex or date of birth), 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 and MA61.