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Last Modified: 4/18/2020 Location: FL, PR, USVI Business: Part A

Reject reason code U5061 FAQ

Q: We are receiving reject reason code U5061. What steps can we take to avoid this reason code?
Click here for a description associated with the Medicare Part A reason code(s). Simply enter a valid reason code into the box and click the submit button.
A: Effective April 1, 2018, you will receive this reason code when a submitted Health Insurance Claim (HIC) number is not found in the Common Working File external pdf file (CWF) crosswalk.
Remember to check with the beneficiary and/or representative for eligibility prior to submitting claims to Medicare.
Click here for resources to verify the patient’s eligibility.
To avoid this reject code in the future a few things you can do when a beneficiary comes to your facility:
Request a copy of the Medicare card prior to providing services.
Verify the eligibility dates on the card are valid for the date of service(s).
Validate the name on the Medicare claim matches the name as it appears on the Medicare card. Do not use nicknames.
If everything matches on the Medicare card, the beneficiary should verify eligibility with the Social Security Administration (SSA).
Source: Provider Outreach and Education
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