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Name Matching Issue with Electronic Claim Submissions

Audience: Participating Providers and Facilities

Thanks to your feedback, we were made aware of an issue with electronic claim submissions where some claims were being rejected due to discrepancies between the information submitted and the information printed on the member card.

On April 1, 2022, the Electronic Data Interchange (EDI) clearinghouse name match edit was updated in relation to the spacing in a member’s name (e.g., La Rhonda vs. LaRhonda). This update also impacted claims containing special characters (e.g., O’Reilly vs. OReilly). On May 12, 2022, we removed the special characters portion of this edit. 

If your office was impacted by this change, please resubmit any claims that were rejected between April 1, 2022 and May 12, 2022 with error A3:31 (Subscriber and policyholder name mismatched). We apologize for any inconvenience this may cause. 

Please share this important information with your billing manager and anyone else within your office or facility who should be aware. If you have any questions, contact your Provider Relations representative.

Thank you for your continued participation with Excellus BlueCross BlueShield and for the quality of care and service that you provide to our members.

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