Remark code MA27 indicates that the claim submitted by the healthcare provider is missing, has incomplete, or contains an invalid entitlement number or name. This entitlement number is typically associated with the patient's eligibility for insurance benefits. The healthcare provider needs to review the claim, correct the necessary information, and resubmit it for processing.
Common causes of code MA27 are:
1. Incorrect patient Medicare entitlement number entered on the claim form, which may be due to typographical errors or outdated information.
2. The patient's name on the claim does not match the name associated with the Medicare entitlement number in the Medicare system, possibly due to name changes or misspellings.
3. The entitlement number is missing from the claim submission, which is often an oversight during the data entry process.
4. The claim was submitted with an invalid entitlement number, such as one that has been deactivated or is not recognized by the Medicare system.
5. Incomplete entitlement information, where only a partial Medicare number is provided or essential details are omitted.
6. Discrepancies between the entitlement number or name provided and the information available in the Medicare beneficiary database, which could be due to recent updates that have not been processed or communicated.
7. The use of an incorrect format for the Medicare entitlement number, as Medicare has specific formatting requirements that must be adhered to for claims processing.
Ways to mitigate code MA27 include implementing a thorough pre-claim review process to ensure that all patient entitlement numbers and names are accurately captured and verified. Staff should be trained to double-check the entitlement information against the patient's Medicare card and other official documents before submission. Utilizing automated eligibility verification tools can also help identify and correct any discrepancies in entitlement information in real-time, reducing the likelihood of this code being triggered. Regular audits of claims can also help identify patterns that may lead to this error, allowing for corrective measures to be put in place.
The steps to address code MA27 involve a thorough review of the patient's insurance information on file. Begin by verifying the patient's entitlement number, which may be their Medicare or other insurance identification number, and ensure that the name on the claim matches exactly with the entitlement documentation. If discrepancies are found, correct the information and resubmit the claim. If the information on file appears accurate, reach out to the patient to confirm their entitlement number and name, as they may have provided outdated or incorrect information at the time of service. Update the patient's profile with the correct details and resubmit the claim. It's also advisable to check for any recent changes in the patient's coverage that might affect their entitlement status and ensure that all other required fields on the claim form are complete and accurate before resubmission.