Remark code MA60 indicates that the claim submitted lacks proper information or contains invalid details regarding the patient's relationship to the insured individual. This means that the payer requires a clear definition of how the patient is related to the policyholder (e.g., spouse, child, self) to process the claim, and this information is either missing, incomplete, or incorrect on the submitted claim form. To resolve this, the healthcare provider must review the claim, correct the patient relationship information, and resubmit it to the payer for consideration.
Common causes of code MA60 are:
1. Incorrect patient demographic information entered into the billing system, such as an error in the patient's name, date of birth, or social security number, which does not match the information associated with the insured.
2. Failure to update the patient's relationship status to the insured, which may have changed due to events like marriage, divorce, adoption, or aging out of dependent status.
3. Data entry errors when selecting the patient's relationship to the insured from a drop-down menu or similar input field, leading to an inaccurate relationship being recorded.
4. Omission of the patient relationship field altogether during the claims submission process, resulting in a lack of necessary information for the payer to process the claim.
5. Inconsistencies between the information provided on the insurance card and the details entered into the billing system, which may occur if the insurance card is outdated or if there was a misunderstanding of the correct information.
6. Systematic issues within the billing software that may auto-populate fields incorrectly or fail to save the updated relationship information properly.
7. Lack of verification of the patient's insurance coverage and relationship to the insured prior to claim submission, which can lead to discrepancies that are only identified by the payer during the claim review process.
Ways to mitigate code MA60 include implementing a thorough patient intake process that verifies the patient's demographic information, including their relationship to the insured. Staff should be trained to double-check this information at the point of service and correct any discrepancies immediately. Utilize electronic health record (EHR) systems with built-in alerts to flag incomplete or inconsistent data entries related to the insured's information. Regularly audit claim submissions to identify patterns of errors and provide targeted education to reduce future occurrences. Additionally, consider using automated eligibility verification tools that can confirm the patient's insurance details and relationship to the insured prior to claim submission.
The steps to address code MA60 involve verifying the patient's demographic information and insurance details. Begin by reviewing the patient's file to ensure that the relationship to the insured is clearly documented and accurate. If the information is missing or incorrect, reach out to the patient or the guarantor to obtain the correct details. Update the patient's profile in your practice management system with the validated information. Once the relationship to the insured is confirmed and updated, resubmit the claim to the payer with the corrected information. It's also advisable to audit your registration processes to prevent similar issues in the future.