I have a claim that needs correcting and the reason code says that the beneficiarys name doesn match the FISS eligibility record. Where can I find out what information doesn match?
After reviewing the information found on page 1 of the ELGA/ELGH eligibility screens, compare this to what is on claim pages 1 and 5 and note any inconsistencies, e.g., does ELGA/ELGH indicate an initial for the first name, which does not appear on your claim? Are there any spaces before or after the name? The patient’s name should match exactly as it appears on ELGA/ELGH. If the claim information is inconsistent, make any necessary changes to both claim pages 1 and 5 and resend the claim for processing. (Jan.-March 2005 FAQ – reviewed Dec.
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