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Medicare 1500 Form Question - Anon


Posted: Aug 27, 2014

Can anybody PLEASE tell me the correct way to put a patient's last name on the 1500 form for a Medicare patient when the last name has three parts separted by spaces, i.e. AA BB CCC, FirstName, MI, which is the exact way the name is on the patient's Medicare card. Medicare denied the claim. Then we put the last name as AABBCCC, but it was denied again. I had a similar problem a few months ago when a patient had a suffix after the last name and was able to call Medicare and was given specific instructions on how to fill out the demographic info in the system so that it will populate the 1500 form the way Medicare (and ONLY Medicare) wants it. Since we don't know how Medicare has this patient's last name in their system, we can't get past the automated system to talk to a human for instructions. Any help would be greatly appreciated! If I didn't explain this well enough, please let me know.

Previous paid claim? - Find another provider who got paid?

[ In Reply To ..]
I confess, this is a mystery to me, but ...

Everything I saw when I googled said to enter it exactly as it is on the card. I also saw tips about being sure if it is the enrollee or dependent you are entering.

Did you verify coverage? Seems you would have had trouble there. Try verifying it again.

I might look for a previous paid claim to see how the name went in. Possibly you can find another physician who has seen that patient? Or a lab or imaging service? They must have had the same problem.

This is a good time to make use of your local AAPC resources. Somebody there does billing or works with billers.





Thanks for your reply - SM - Anon

[ In Reply To ..]
When I googled it, I found the same answer as you. Yes, coverage was verified on VisionWeb, and the patient's info came up without a problem and her name exactly as it is on the card (last name as AA BB CCCC, FN, MI). She has no previous claims with our office. Unfortunately, we work for two small offices owned by the same doc, and neither of us insurance coordinators is certified. I glanced at the AAPC web site but don't know if we need to be degreed and/or certified to join. Thank you very much, though, for your reply.

Joining the AAPC is not necessary - Suggestion

[ In Reply To ..]
I just noticed that you said you do not know how Medicare has the name in the system. What is on her card? That should be how it is in their system. That's why the instructions online say to enter the name exactly as it is on the card.

You wrote AA BB CCCC, FirstName, but should it be aa bb Cccc?

To answer your second post ... see if she has a claim with a different physician. Was she referred by anyone? Did she menton seeing anyone else in the past?

Joining the AAPC is not necessary. I suggested using your local AAPC members for advice. Look on the AAPC website to find your nearest group. A contact number will be listed. Phone or email that person and ask if they can help you find someone to help you.

No degree or certification is required for membership, though. But, again, you don't need to join.

I think you should also consider asking the patient about the name. Does she have a copy of an old Explanation of Benefits from Medicare?

Does she have a secondary carrier? If you can't phone the Medicare carrier, maybe the secondary is more accessible.

Even if she does not have a secondary, you have a list of secondary carriers (AARP, etc.), don't you? Call them and ask for help.

Can you call billing at a local hospital? Speak to a supervisor.
Thanks, was able to call Medicare - anon
[ In Reply To ..]
I was asking for my co-worker who works in the other office. She did file the claim with the patient's name EXACTLY as it is on the Medicare card (I viewed the claim). Name capitalization is irrelevant as the info populates on the 1500 form in all caps.

Patient does not have a secondary insurance. Probably won't get help from AARP or any other secondary as you can't get past the automated menus without a patient ID#,and this patient is not a policy holder.

I was able to talk to somebody at Medicare this morning and he said the problem may be with our clearing house. However, that is ALWAYS their excuse. I had this a problem with units/days being changed from 90 to 1, and they blamed it on the clearing house. Called the clearing house; it was not their problem. After three more calls to Medicare, finally got somebody to admit they have a computer programming error (which they still haven't fixed in over two months as my claims are still denied). Medicare is just a pain to deal with.

Thanks for your suggestions.


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