10.2 Block numbers 1-11
Blocks 1-11 contain information about the patient and the insured. The patient is required to enter his name on the Medicare card, his birth date and sex. Moreover, if the patient and the insured are one and the same person, the patient is required to enter the word SAME in the Medicare card. More so, the patient is required to provide his telephone number and his permanent address. In the event that the insured is not the patient, the patient is supposed to indicate his relationship to the insured. Additionally, if the insured and the patient are not the same person, the patient must provide the insured’s permanent address. Most importantly, the patient is supposed to check the appropriate box for his marital status and to indicate whether he is employed or a student. It is however worth pointing out that incorrect formatting may lead to the rejection of a claim. For instance, in case, the patient indicates that he is the same as the insurer yet that is not the case, the claim cannot go through.
Upon receiving an incomplete submission, The A/B MACs (A) will return the submission to whoever was in charge of processing the data if at all it contains any inaccurate element. However, as long as the data is recorded in the appropriate field, A/B MACs will process the submission. Moreover, if a conditional element is entered inaccurately in the appropriate field, the submission must be returned to the service provider. Also worth of pointing out is the fact that “clean” claims are claims that are processed through the remittance process. On the other hand, “Other-than-clean” claims are those that require investigation (Services, 2019) . Due to the process involved in clearing the “Other-than-clean” claims, they take longer than “clean” claims to be processed.
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References
Services, D. o. (2019). CMS Manual System: Pub 100-04 Medicare Claims Processing. Centers for Medicare & Medicalk Services.
