HI 00825.115 CMS-1725 (Program Service Center Referral)
The CMS-1725 originates in the CMS, Group Premium Payment Branch (GPPB) in Central
Office. Miscellaneous health insurance information and/or correspondence is received
in the GPPB from carriers and intermediaries. When a discrepancy is noted or it appears
a program service center action is necessary, an CMS-1725 is prepared and sent to
The appropriate PSC component, Mail and Direct Input personnel, a Benefit Authorizer,
or an Exceptions and Inquiries Specialist will review the folder in conjunction with
the CMS-1725 and any attachments. If, based on such review, an adjustment to the MBR
is in order, corrective action must be taken. If the CMS-1725 and the MBR are in agreement,
no action is necessary. A reply to CMS, GPPB is required only if the PSC disagrees
with the information furnished (either on the CMS-1725 or the attachments).
Please note, the receipt of the CMS-1725 only indicates the folder should be reviewed
to insure the MBR is correct. It does not mean something is definitely wrong on the
The CMS-1725 has been revised to meet current needs. See HI
00825.912 for a sample of the revised form.
In some instances, a Health Insurance Printout (HIPO) will accompany the CMS-1725.
This printout will assist the reviewer in recognizing possible discrepancies between
the Health Insurance Master (HIM) and the MBR. See HI 00825.913 for a sample HIPO and an explanation of pertinent data contained thereon.