Last Modified: 2/5/2010
Location: FL, PR, USVI
Business: Part A
The Centers for Medicare & Medicaid Services (CMS) records indicate the beneficiary is not in file. Please verify the beneficiary's identification and submit a new claim.
Resources/tips to avoid or correct this return to provider (RTP) code
There are a few things you can ask the beneficiary when they come to your facility:
1. Do you have a Medicare Red/White/Blue card?
• Is the eligibility date on the card valid? Is it a future date?
2. Have you recently moved from another state?
• If so, did they contact the Social Security Administration (SSA) or Medicare to update the files?
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 pull the eligibility information by using the ELGA (Eligibility Part A) or HIQA (Health Insurance Query Part A) screens.
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Source: FCSO Education Action Team
