Medicare Top 10 denials - 4. Beneficiary Eligibility



MRA reason code CO-140: Patient/Insured health identification number and name do not match.

Or,

MRA reason code CO-16: Claim/service lacks information which is needed for adjudication.

Remark Message MA27: Missing/incomplete/invalid entitlement number or name shown on the claim.


Resolution

Claims often deny for eligibility for the following reasons:

-- The beneficiary’s Medicare number is invalid on the claim.

-- The beneficiary is not eligible to receive Medicare benefits.

·--The beneficiary’s claim must be filed to another insurance plan.
These types of rejections can be resolved by taking extra steps to ensure patient information is complete and accurate. Some suggestions are:


1. Patient screening is a vital step that all Medicare providers should include in their office procedures.

2. A copy of the Medicare card should be made and the claim submitted to Medicare exactly as the patient’s name and number is printed on the card. This will eliminate or reduce beneficiary eligibility errors.

3. The provider should verify the patient’s effective date for Medicare Part B from his Medicare card. Medicare cannot pay for services prior to the patient’s effective date and will not pay for services if the patient has terminated his Medicare benefits.

4. Claims for beneficiaries who enroll in a Medicare “replacement” plan must be submitted to that insurance plan instead of TrailBlazer.

5. To obtain Medicare eligibility, providers should call the IVR.

6. Providers may also utilize the online inquiry system to check patient eligibility.

7. Reporting nicknames instead of legal names shown on the Medicare card will cause

claim rejections. Providers must remember to include the suffix Jr. or Sr. if listed and if applicable. If the suffix is applicable and omitted from the claim, a rejection will occur.






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