CAQH CORE 258: Normalizing Patient Last Name Rule (Eligibility & Claim Status Operating Rules)
CAQH CORE 258: Normalizing Patient Last Name Rule does not require that a health plan use the patient’s last name in its search and matching logic for locating an individual within its systems. Further, the rule does not specify the search criteria used by a health plan (or information source) to identify a patient in its systems. That is, when the last name is not used in the health plan’s search/match logic – the rule does not apply – and if the health plan receives the patient’s unique ID number in an X12 270 eligibility inquiry, it may use or ignore the name or other demographic data about the individual if not needed or used to uniquely locate that individual in the plan’s systems.
The CAQH CORE 258 Rule includes the character string “II” in the set of specified character strings to be removed during normalization (Section 4.2.2.) Additionally, the rule in Section 4.2.1 defines how to normalize the last name, to wit: “To normalize the submitted and stored last name remove all of the character strings specified in Section 4.2.1 when they are preceded by one of the punctuation values specified in Section 4.2.3 and followed by a space or when they are preceded by one of the punctuation values specified in Section 4.2.3 and are at the end of the data element and remove the special characters specified in Section 3.7 in the name element. If the last name as submitted and as stored is not delimiting the suffix using one of the specified punctuation values or store the suffix separately, the normalization logic will not remove the character string “II”. The CAQH CORE Rule does not specify HOW an entity must store a last name, but does make recommendations on this issue in Sections 4.1.1 and 4.1.2.