Modification to Return Submitted Information When There is a CWF Name and HIC Number Mismatch
INDUSTRY NEWS TAGS: CMS
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. Your contractor will use Reason Code 140 (Patient/Insured health identification number and name do not match) and remittance advice codes MA130 (Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information) and MA61(Missing/incomplete/invalid social security number or health insurance claim number). 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.