Birth Date Edit

A birth date edit is applied to all pharmacy claims.

If a member’s submitted birth date, i.e. month, day and year, does not match what is in the claims processor’s record, a denial message is returned indicating an error in the birth date. The denial message includes the MMYY of the birth date on file with the claims processor.

When the birth date denial message appears, please follow the procedures outlined below:

1. Confirm with the member that the information that the pharmacy is submitting is correct, and resubmit the prescription with a corrected membership number, person and/or relation code, if applicable.
2. If the pharmacy determines that the prescription is for the right person, but the submitted date of birth does not match the claims processor, the pharmacy should resubmit the claim, using the MMYY that was returned on the denial message to complete the processing of the claim.

HMSA runs monthly reports to identify and correct birth date errors.

Revision History