Last Modified: 10/17/2017 Location: FL, PR, USVI Business: Part A, Part B
Common working file (CWF) name and number mismatch
Effective for claims processed on/after October 1, 2012, change request 7260 implemented a requirement for Medicare systems (FISS/MCS) to return claims when the beneficiary’s name does not match the health insurance claim number (HICN) on the Common working file (CWF). These claims will be handled as follows:
• Part A claims will be returned to provider (RTP)
• Part B claims will be returned as unprocessable
If you receive a remit indicating the patient/insured health identification number and name do not match, you must advise the patient or his/her representative to contact their local Social Security office to have their files updated. Once the update has been made, you may submit a new claim for processing.
Note: Appeal rights are not afforded on claims that are returned to the provider or handled as unprocessable.
Additional information is available at http://medicare.fcso.com/Publications_A/2012/236925.pdf#page=15 (Part A) or http://medicare.fcso.com/Publications_B/2012/236923.pdf#page=39 (Part B).
Source: CR 7260
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.