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Printed Date: 9/22/2015
Problem: Missing beneficiary name. Please make corrections and resubmit.
Effective with the September 2010 system release, the beneficiary's name must be entered on page one of claim. The beneficiary info no longer auto-populates on pages one and five of the claim after entered on claim entry screen.
Explanation and Suggestions
Providers who enter claims directly in the Fiscal Intermediary Standard System (FISS) (referred to as direct data entry, or DDE) are required to enter in the patient’s last name and first name, in addition to the Health Insurance Claim Number (HICN), on FISS Page 01. This has always been a requirement for DDE. However, a recent edit was installed to ensure the patient’s name is keyed by the provider. If a claim is keyed into DDE and is missing the last and/or first name on FISS Page 01, the claim will be returned to the provider (RTP) with reason code 16501. Please ensure that your billing staff is aware of this new editing, and are keying the patient’s name into FISS Page 01 as required.
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Last Updated: 01/11/2018