CMS Pub. 100-04, ch. 27, § 20.3.3.6

The Host provides the Satellite with this disposition code and Trailer 08 with error code

5052 when it discovers a mismatch of the Health Insurance Claim Number (HICN) with

the beneficiary’s personal characteristics such as name, sex or date of birth.

If CWF rejects a claim and sends back disposition code 55 with the 08 trailer containing

Error Code 5052 when the beneficiary’s personal characteristics do not match the HICN

in accordance with the CWF matching criterion, contractors shall return the claim to the

provider as unprocessable with the identifying beneficiary information from the

submitted claim as follows:

A/B MACs (A, HHH) shall return to provider (RTP) Part A claims. These A/B MACs

shall not mail an MSN for these claims.

A/B MACs (B) and DME MACs shall return as unprocessable Part B provider

submitted claims. The A/B MACs (B) and DME MACs shall not mail an MSN

for these claims. When returning these claims as unprocessable, the shared

processing system shall use Claim Adjustment Group Code (Group Code) CO –

Contractual Obligation, Claim Adjustment Reason Code (CARC) 16 -

Claim/service lacks information or has submission/billing error(s) which is

needed for adjudication. Do not use this code for claims attachment(s)/other

documentation. At least one Remark Code must be provided (may be comprised

of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code

that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification

Segment (loop 2110 Service Payment Information REF), if present with

Remittance Advice Remark Codes (RARCs) MA27 - Missing/incomplete/invalid

entitlement number or name shown on the claim and N382 -

Missing/incomplete/invalid patient identifier.

For assigned and non-assigned Part B claims submitted by the beneficiary on the Form

CMS-1490S or Form CMS-1500, A/B MACs (B) and DME MACs shall manually return

the claim in accordance with Pub.100-04, Chapter 1, Section 80.3.2 A. "Special

Considerations."