Patient ID Mismatch

Common Causes for 140

Denials with code 140 typically happen for the following specific reasons:

• Patient name entered with different formatting or spelling variations (e.g., 'Robert' vs 'Bob', 'Mary Jane Smith' vs 'M.J. Smith', hyphenated names entered without hyphens)
• Health insurance ID number transposed or entered with incorrect digits during registration or claim submission, creating a mismatch with the name on file
• Recent name changes (marriage, divorce, legal name change) not updated in the payer's system, causing the current claim name to not match historical enrollment records
• Patient demographic data entry errors at point of service, such as using a nickname instead of legal name or entering an outdated ID number from a previous plan year
• Secondary insurance or dependent coverage confusion, where the claim is submitted under one family member's ID but with another family member's name

How to Prevent 140 Denials

To avoid receiving this denial in the future, implement these specific checks:

• Implement real-time eligibility verification at check-in that pulls the patient's exact name and ID as stored in the payer's system, then compare against registration data before claim submission
• Establish a pre-claim audit process that flags any claims where the patient name and ID combination don't match the payer's master file, requiring manual review and correction before transmission
• Train front-desk and billing staff to always request and verify the patient's current insurance card, capturing the ID number exactly as printed and confirming the legal name matches the card
• Create a patient demographic update protocol that requires staff to document and submit name changes to all active payers within 24 hours of learning of the change, with confirmation of receipt
• Use claim scrubbing software configured to validate patient ID and name combinations against payer databases before claim submission, automatically rejecting claims with mismatches for correction

Appeal Letter Template for 140

If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.

[Your Practice Header]
[Date]

[Payer Name]
[Appeals Department Address]

RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: 140 - Patient ID Mismatch

Dear Appeals Department,

I am writing to appeal the denial of the above-referenced claim, which was denied with code 140: "Patient ID Mismatch".

We respectfully request reconsideration of this denial. The claim was submitted with accurate patient identifiers as provided by the patient at the time of service and as reflected in our medical record documentation. The patient's legal name and health insurance ID number on the claim correspond to the same individual and coverage period. We have verified the patient's identity through [insurance card/verbal confirmation/previous EOB], and any discrepancy appears to be a data entry or system matching issue on the payer's end rather than a billing error on our part. We request that the payer conduct a manual patient account lookup using the provided identifiers and reprocess the claim under the correct patient record. We are prepared to provide additional documentation (insurance card copy, patient ID verification, previous claims history) to facilitate this match and expedite payment.

Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].

We respectfully request that you reprocess this claim for payment.

Sincerely,

[Your Name]
[Title]
[Practice Name]