Medicare Name and Number Mismatch


Beginning April 1, 2013, all physicians, providers, and suppliers submitting claims to Medicare will no longer see a correct name or HIC number on remittance advices/835’s, FISS, PPTN when an incorrect name or number are used. CMS Change Request 7260 issued to your FI, A/B MAC, and DME/MAC regarding this change may be viewed here, on the Centers for Medicare & Medicaid Services (CMS) website. Verifying Medicare eligibility prior to claim submission using the CMS HETS system via PayerLink will ensure providers are submitting claims with the correct beneficiary HIC number, name, sex or date of birth.

For more information regarding PayerLink, click here.

Integrate eligibility inquiry in your software

Beginning April 2013, CMS will start terminating existing DDE screens containing patient eligibility data for all providers. CMS has recommended that providers begin searching for vendors that can deliver access to the HETS (Healthcare Eligibility Transaction System) for delivery of Medicare eligibility and billing history data. Our HETS service can provide this access for you immediately with no development time required by your staff.

Business-to-business (B2B) Eligibility Verification Solution