CAQH CORE 258: Normalizing Patient Last Name Rule

CAQH CORE 258 Operating Rule requires the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. CAQH CORE 258: Last Name Normalization Rule Version 2.1.0 does not address this specific scenario. Since the characters “De” are not included in the specified set of character strings to be removed, any validation of the last name performed by the health plan would naturally be against what was submitted in the Last Name data element in the X12 270 request against what the health plan maintains in its eligibility system. This is outside the scope of the CAQH CORE Rule.

With regard to Section 4.2.2–Character Strings To Be Removed During Name Normalization, what recommendations does CAQH CORE have for instances where the last name contains concatenated last name + suffix? For example, with the patient name JAMES C POMP II, last name may be stored as “POMPII”. How can we tell if the last name should be “Pomp” And Not “Pompii” and strip the “II” by mistake? While the instance of a Jr./Sr. suffix can easily be identified, others such as “MD” and “RN” will be more difficult to identify as in the case of a name ending in “RN” like “BURN”). In most cases the last names are concatenated with suffixes and not in a separate field and not easily identifiable.

The CAQH CORE 258 Rule includes the character string “II” in the set of specified character strings to be removed during normalization. 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”.

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