Disposition Code 51 (True Not in File on CMS BatchSystem)

20.3.3.2 - Disposition Code 51 (True Not in File on CMS BatchSystem) (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) The Host gives this response with a 08 Trailer and error code 5052. The CMS has performed an alpha search of its records and cannot locate the beneficiary's records. Alpha search is the process of searching for the records based on the first six positions of the surname. All beneficiaries with the same first six letters in their surnames are listed with their HICNs. The system checks for possible matches, including the possibility that numbers were transposed. This search is performed only if no match is found during the search by HICN. This code can be given in two forms: 1. With Trailer 01 - Trailer 01 will contain a possible corrected HICN. The A/B MAC or DME MAC investigates the possible HICN and, if it believes the new HICN is for the same beneficiary, it resubmits the claim with the new HICN to the Host. The CWF will respond with the appropriate disposition code and any associated trailers for processing the claim. 2. Without Trailer 01 - This response indicates that after performing the alpha search operation, no match is found against the HICN submitted and CMS records. Since Medicare eligibility cannot be established, A/B MACs and DME MACs shall return the claim to the provider as unprocessable and take the following actions: • A/B MACs (A, HHH) shall return to provider (RTP) Part A claims. A/B MACs (A, HHH) shall not mail an MSN for these claims. • A/B MACs (B) and DME MACs shall return as unprocessable Part B claims. A/B MACs (B) and DME MACs shall use Group Code CO and Claim Adjustment Reason (CARC) 140 (Patient/Insured health identification number and name do not match). A/B MACs (B) and DME MACs shall not mail an MSN for these claims. • For assigned and unassigned 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."