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TO:              All Medicaid Providers
FROM: Randy May, Deputy Administrator
Effective March 1, 2005, claims submitted to Idaho Medicaid will be denied for edit 101 “Client name and/or number does not match client file” if the name submitted on the claim does not exactly match the name as it is contained within the claims processing system. 
A study was conducted to determine what would cause claims to set this edit.  The top reasons are as follows:
§         Claims are submitted using a nickname or some other variation of the client’s name (i.e., Mike vs. Michael, Sue vs. Susan, Edward vs. Ed, etc.)
§         Claims are submitted with a different last name.  The client may have changed names however has not informed their Self Reliance Worker, so the change has not been made within the claims processing system.
§         Claims are submitted with the first or last name misspelled.
§         Claims are submitted with a space between letters.  For example, OConnor is submitted as O Connor, McDonald is submitted as Mc Donald, etc...
§         Claims are submitted with special characters such as an apostrophe (‘), hyphen (-), period (.), comma (,) or asterisk (*). 
Entering client names exactly as it appears on the Medicaid ID card will prevent these errors from occurring.  Be sure to enter the last name first, followed by the first name and middle initial.
A identification card is issued at the time a client becomes eligible for Medicaid benefits or whenever a name change is reported.  The card number in the lower right hand side of the identification card is updated anytime a new card is issued for that client.  When eligibility is being verified, the client’s card number should also be verified to ensure that the card being presented is the client’s most current card.  If the card number on the identification card matches the card number reported by the eligibility verification system, then the name on the card will also match what is in the system.  If the card number is lower than what is reported by the eligibility verification system, then the client’s most current card should be requested from the client.  Providers should request the card with picture identification and retain copies of this documentation for your records.
When verifying eligibility via the Medicaid Automated Voice Information Service (MAVIS), providers have the option to request that the eligibility information be faxed to them.  The faxed information will report the client’s name exactly as it is listed on the system which is how it should be submitted on the claim.  This information is also reported on the printout when verifying information via the POS device.
There is a possibility that the client’s name may change between the time that eligibility is verified and the claim is submitted.  Unfortunately there is no way to prevent these types of mismatches from occurring.  The claim will be denied for edit 101 and providers will need to resubmit the claim with the updated name.
If you have any questions concerning the information contained in this release, please contact EDS Provider Services at (208) 383-4310 or 1-800-685-3757.  Thank you for your continued participation in the Idaho Medicaid Program.
This Information Release replaces information in section 2 of your Idaho Medicaid Provider Handbook along with other necessary areas.