Cardholder ID

The number entered in “Cardholder ID” (Field 302-C2), in combination with "Group ID" (Field 301-C1), identifies the program to which the claim is submitted for payment. For people eligible for more than one program the adjudication process will refer submitted claims to the appropriate payer based on the following hierarchy:

  1. Medicaid
  2. Kidney Health Care (KHC) program
  3. Children with Special Health Care Needs (CSHCN) Services Program

For example, when a claim for a Medicaid/CSHCN dual-eligible person is submitted using the CSHCN cardholder number, and the claim is payable by Medicaid, the claim will reject with code “41" ("Submit Bill To Other Processor or Primary Payer"). The system will return one of the two messages below.

Message Meaning
Client has Medicaid ID. Resubmit using the using the Medicaid ID# nnnnnnnnn
(ID Number)
This claim needs to be re-submitted using the Medicaid number provided.
Correct and Resubmit using Med #nnnnnnnnn

Additional errors on the claim must be corrected prior to Medicaid resubmission.  These errors are considered correctable and “non-fatal” and apply to the referred program (in this example, Medicaid) and not to the submitted program (in this case, CSHCN).