Description:
Private Business uses controls on the member identification number to identify specific member, spouse or dependent information.  This includes dependents with a different last name and Medicare status.

Policy:
Dependent with Different Last Name
A dependent with a different last name from that of the member must be identified as a covered dependent under the policy.  This dependent must meet the employer’s eligibility requirements for dependent coverage.  Please refer to the specific plan of benefits for requirements.

No claims should be paid in "different last name" cases unless a control 02 is on file. In CES, an "exception rule", should be entered and found in the Subscriber Contract Status / Information Menu, (SEIU). Different last name information should be found by keying a "M" in the "select option" field for Member status.

Medicare Status
Medicare COB record is entered to indicate the Medicare status for the subscriber and/or his/her dependents (in CES).  Medicare information should be entered and found in the SUBSCRIBER CONTRACT STATUS/INFORMATION MENU (SEIU) screen information, "C" for COB.  Requests to add or change Medicare status information are received through written correspondence or telephone inquiry.  Proper documentation is required before a control is entered.

When a written request to change or add Medicare status information is received, the request document must be imaged prior to changing or adding Medicare information.  When a telephone inquiry request to change or add Medicare status information is received, the Member Service Representative taking the call must complete a request (usually an Action Request).  This request must be imaged prior to changing or adding Medicare information.  The image number of the request is entered in the "claim #" field of the COB information screen.

NOTE:
Many groups require that the transactions described above be routed through the group leader.  For these situations, the group’s required procedures should be followed.