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Last Modified: 11/9/2011
Location: FL, PR, USVI
Business: Part A
Avoiding reject reason code T5052 FAQ
Q: What steps can we take to check if our patient is eligible for Medicare and avoid reject reason code T5052 on the claim?
A: Here are some things to verify when a beneficiary comes to your facility:
• Do they have a Medicare Red/White/Blue card?
• Are the eligibility dates on the card valid? Is it a future date?
Even when you have answers to these questions, always remember to check beneficiary eligibility prior to submitting the claims to your Medicare contractor. Here are some additional ways to obtain this information:
1. Direct data entry (DDE) 
users can access the eligibility information by using the ELGA (Eligibility Part A) screen.
users can access the eligibility information by using the ELGA (Eligibility Part A) screen.2. Contact the interactive voice response (IVR) system by calling (877) 602-8816.
system by calling (877) 602-8816.Always remember to check beneficiary eligibility prior to submitting claims to Medicare.
Definition
Reject reason code T5052:
The Centers for Medicare and Medicaid Services (CMS) records indicate the beneficiary is not in file. Please verify the beneficiary's identification and submit a new claim.
Source: Provider Outreach and Education department
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