HI 00910.001 District Office Responsibility for Providing Claim Numbers

Providers, physicians, suppliers, intermediaries, and carriers may request claim numbers from the DO when they are unable to obtain them from the beneficiaries. In addition, carriers and intermediaries will ask for verification of the claim number when they receive a code 52 reject in response to a query transmitted to CMS.

A code 52 reject means that the name and number submitted by the intermediary or carrier did not exactly match the information on the health insurance master tape or that there is no record of that particular claim number in a processing center.

DO"s will make every effort to provide the requested information, when available from DO records, within 24 hours (48 hours if more than one DO is involved). When the requested information is not available from the microfiche or other DO records and additional checking is necessary, an interim reply may be given to the requester. The Regional Medicare Directors CMS, SSA RO"s and DO"s parallel to requesters will develop the necessary local procedures for handling requests and, where needed, interim replies.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600910001
HI 00910.001 - District Office Responsibility for Providing Claim Numbers - 11/23/2001
Batch run: 01/27/2009
Rev:11/23/2001