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Issue 2006-05, May 2006
Claims Returned to the Provider with Reason Code 30715
When conducting data analysis, we have found that reason code 30715 is consistently in the top ten reasons claims are being returned to provider (RTP). In an effort to reduce the frequency of this error, we are reminding providers that claims cannot be processed if the beneficiary’s name does not match what is listed on the common working file (CWF).
Why was the claim RTP?
- The patient’s last name and or first initial do not match CWF information.
Provider action:
- If the HIC number submitted was incorrect, submit a new claim.
- If the name on page one is misspelled, contact Empire Medicare Services (EMS) for correction.
- If the name on page one is correct, check page five to ensure name matches page one.
- If the name is incorrect, correct name on page five and resubmit.
- Once claim(s) have been corrected, put in internal measures to prevent future claims from being returned for this reason code. For example:
- CWF should be checked prior to the claim being submitted.
- The registrar has to verify the beneficiary eligibility information.
- Have the registrar check to see how the name is spelled in CWF.
This will ensure that the beneficiary’s name is entered in your internal system correctly.
It is the provider’s responsibility to correct claims that have been RTP. These claims can hold up any potential Medicare payment if not corrected.
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