Top Claim Submission Errors for All Providers: Error N5052
Reason for error: The beneficiary's Medicare ID number, name, sex, or date of birth submitted on the claim does not match the Medicare ID number, name, sex or date of birth in the Common Working File (CWF) eligibility records.
Claim processing result: Return to Provider
How to prevent/resolve:
- Before submitting your claim, verify that the beneficiary's personal characteristics (name, sex or date of birth) and Medicare ID number on your claim matches page 1 of ELGA or ELGH. In addition to the correct spelling of the name, if ELGA/ELGH includes a space in the last name, you must also include a space when submitting your claim, or vice versa (e.g., McDonald vs. Mc Donald). Likewise, do not include a comma or a period unless the name appears as such on ELGA/ELGH (e.g. John Smith Jr vs. John Smith, Jr.). Refer to "Chapter 2: Checking Beneficiary Eligibility
" for information about ELGA and ELGH. For additional information and the various systems available for providers to check eligibility, visit the "Checking Beneficiary Eligibility" CGS web page. - Other resources that are available to verify the beneficiary's name, sex, date of birth and Medicare ID number include:
- Interactive Voice Response (IVR), 1-877-220-6289. Refer to the IVR Guide for additional information.
- Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS). For information about HETS, refer to the HETS User Guide
. - myCGS online web portal. For additional information about myCGS, refer to the myCGS User Guide.
Posted: 12.14.18
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