Known Issue: MHP rejecting claims for client name

Kevin Holmes 8 years ago in Known Issues updated 8 years ago 2

We've been informed that Metropolitan Health Plan / Hennepin Health is in the process of making changes that may affect your claims (see attached info).

The most specific change that MHP has been implemented is that client demographic information must match exactly with MHP, including first name, last name, middle name or initial, and date of birth.

We're seeing several rejections on claims due to the middle name or initial not matching what MHP has on file.

For example:
If MHP has only the initial on file in their system, then that is what is needed on the claim.

The rejection in the Procentive Electronic Module reads: MEMBER MIDDLE NAME DOES NOT MATCH

Please go to the Electronic module and review all batch reports for MHP (even if they say "Received") starting on 8/15/16, to be sure that your claims have gone through successfully.

If you have further questions please submit a ticket to the Procentive Support Desk.

MHP and client name issue


UPDATE: MHP has postponed the live date for their new demographic edits. Because the eligibility on their website did not display the middle name, they could not go live with this edit because the providers really had no way of getting accurate information for populating the demographic information on their claims.

Once this issue has been resolved at MHP, a new go-live date for the edits will be set.
Any claims that rejected will NOT need to be resent. MHP has informed us that they did accept them for adjudication and they should be processing as usual.

UPDATE: Claimlynx has informed us that MHP is going to go live with their new client demographic requirements effective November 1st. Starting then, all claims must match what MHP has on file in their system with regards to client name, including middle name/middle initial, otherwise they will reject the claim.

For example, if MHP has entered in their system Jon Adam Doe and you were to bill Jon Doe or Jon A. Doe, the claim will reject. So you will need to be sure they enter into Procentive exactly what is entered on the client's ID card for claims to process correctly with MHP.

If you have questions or concerns, let us know.