Unprocessable Claims
Q. If a claim is returned as unprocessable (e.g., if the name does not match Medicare’s records), what responsibility does the beneficiary/provider have?
A. To resolve a claim returned as unprocessable, providers should correct the data and submit a new claim using the name and number as they appear on the Medicare card. If the beneficiary insists that the Medicare card is incorrect, the provider should advise the beneficiary to contact their local servicing Social Security Administration Field Office to obtain a new Medicare card. A claim returned as unprocessable for incomplete or invalid information is not afforded appeal rights.
(Last Modified 9/27/07)
Source: CMS IOM Pub 100-01 - Medicare General Information, Eligibility and Entitlement Manual, Chapter 2, Section 50; Pub 100-04 - Medicare Claims Processing Manual, Chapter 1, Sections 80.3.1, 80.3.2 & 80.3.2.1.1B
