1. If a health plan receives the subscriber ID number and the subscriber last name in the X12 270 inquiry, does the health plan have to use the subscriber last name or can they ignore the subscriber last name when processing the X12 270 Inquiry?

The CAQH CORE 258 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.

2. 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

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 th

3. We have a situation in which some beneficiaries may have two last names as in the case of beneficiaries in Puerto Rico in which a married woman will keep her last name and add “de” as the prefix to her husband’s last name (e.g., Maria Garcia DeSanchez)

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.

4. In reviewing the rule, I could not find any statement on how hyphenated or apostrophized last names would be handled, e.g., O'Donnell-Griswold? Would it be just Odonnell? Or is this something which is or has been addressed in another CAQH CORE Rule?

CAQH CORE 258: Last Name Normalization Rule Version 2.1.0 DOES require the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. Section 3.7 (3) lists the X12-designated “special characters” of the “Basic Character Set” and the list includes both the apostrophe and the hyphen. Section 4.2.1 of the rule then says “remove the special characters specified in §3.7 in the name element.”