The Centers for Medicare & Medicaid Services (CMS) released a new transmittal reverting to its pre-Oct. 1 policy of handling claims where the Health Insurance Claim Number (HICN) does not match the beneficiary name associated with that HICN. The policy that went into effect on Oct. 1 required an exact match of the beneficiary’s first initial and the first six letters of the last name (including special characters) or the claim would be returned. It is hopeful the new edit, effective April 1, will resolve this issue.
The new policy changes the current CWF and shared system processes so that if there is a HICN and name mismatch within CWF, the submitter will receive the information it originally submitted when the claim is returned. CMS is also eliminating from §188.8.131.52 the bullet point that required the Host to return what it believed to be the proper information.
Click here to download the policy R2670CP in PDF format.