Medicare Information Resource, Issue 2007-3A:

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MIR-2007-3A, March 2007

Quick Tip: Verifying Beneficiary Information with the Common Working File (CWF) to Avoid and Correct

Reason Code 30715

Reason code 30715 is consistently among the top ten reasons claims being returned to provider (RTP). 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.

This Quick Tip is designed to remind providers that claims cannot be processed if the beneficiary’s name does not match what is listed on the common working file (CWF). The purpose of this information is to help providers reduce the number of RTP for reason code 30715.

Why are Claims RTP with Reason Code 30715?
The patient’s last name and or first initial do not match CWF information.

Avoiding Reason Code 30715

Have registration/admission staff verify the information in the CWF by going into OMNIPRO SM, prior to claim submission.
Check with your registration/admission staff to see how the name is spelled in their system.

This will ensure that the beneficiary’s name is entered in your internal system correctly.

Correcting Claims RTP with Reason Code 30715

If the HIC number submitted was incorrect, submit a new claim.
If the name on claim page one is misspelled, contact National Government Services for correction (1-888-855-4356).
If the name on claim page one is correct, check claim page five to ensure name matches page one.
If the name is incorrect, correct name on claim page five and resubmit.