Name Mismatch = Claim Rejection

CMS transmittal 2449 instructs Medicare Administrative Contractors (MACs) to reject claims if the name on the claim is not an exact match to the name associated with the Health Insurance Claim Number (HICN) in the Common Working file (CWF). The effective date of this change was October 1, 2012.

Numerous claims are being rejected at this time due to a mismatch. For example, if the patient’s name is McDonald and their information in the CWF has a space between the “Mc” and the “Donald”, then you must have a space on your claim form. If the patient has a hyphenated name, it must match exactly on the claim to the Medicare card or the claim will reject. Rejected claims can be corrected but this delays payment.

Take this opportunity to re-educate staff on the importance of securing a copy of the patient’s Medicare card and the significance of accurate data entry.