Remark code MA36 indicates that the claim has been flagged because the patient's name is missing, incomplete, or invalid. This requires the healthcare provider to review the patient information submitted and correct any errors or omissions in the patient's name to ensure proper claim processing.
Common causes of code MA36 are incorrect patient information on the insurance claim form, such as typographical errors in the patient's name, submission of a nickname or an abbreviated name instead of the full legal name, or discrepancies between the name on the insurance policy and the name provided during registration. Other causes may include outdated or changed patient names not yet updated in the provider's records or insurance database, such as after a legal name change due to marriage or divorce, and missing middle initials when they are required by the payer for patient identification.
Ways to mitigate code MA36 include implementing a meticulous patient information verification process at the point of registration. Ensure that all staff members are trained to double-check the patient's name for accuracy and completeness on all forms and electronic records. Utilize electronic health record (EHR) systems with built-in prompts and alerts that flag missing or incomplete patient names before the claim is submitted. Regularly audit patient files and claims to catch and correct any discrepancies in patient names promptly. Establish a protocol for patients to review their demographic information during each visit to confirm that their name is recorded correctly.
The steps to address code MA36 involve verifying the patient's demographic information. Begin by reviewing the patient registration form and the insurance claim to ensure the patient's name is spelled correctly and matches the name on the insurance card. If discrepancies are found, correct the information in the billing system and resubmit the claim. If the patient's name is correct, contact the insurance payer to clarify the specific issue they have identified and make any necessary updates. It may also be beneficial to reach out to the patient to confirm their legal name, including any middle initials or suffixes that may be required by the payer for claim processing. Once the patient's name is validated and updated as needed, resubmit the claim with the correct information to the payer for processing.