TN 2 (02-91)

HI 00901.245 Correction of Health Insurance Cards - FO Action

A. Procedure - MISSPELLED GIVEN NAME OR SURNAME

Send a HI/MBR Status Query (HMQ) (see SM 00706.005) on the affected claim number. The following describes the FO action necessary to correct misspelled names as determined by the information contained in the query replies:

1. MBR Correct/HI Correct

If the MBR benefit name and the HI name are both correct, transmit a HIC to CMS. (See SM 00706.025.)

2. MBR Incorrect/HI Correct

If the MBR benefit name is incorrect and the HI name is correct:

  • Transmit a HIC query if a new card is needed.

  • Prepare an SSA-3709 (MBR Record Correction Direct Input
    (MISCOR)) to correct the MBR.

NOTE: If the MBR is still incorrect after 30 days, prepare an CMS-2178 annotated “Follow-up” and send it to the processing center.

3. MBR Correct/HI Incorrect

If the MBR benefit name is correct and the HI name is incorrect:

  • Prepare an CMS-2178. (See HI 00930.080.)

  • Forward the original (white copy) and a photocopy of the HI card, a photocopy of the microfiche, or the HI portion of the HMQ to CMS. (CMS corrects the HI master and issues a corrected HI card (CMS-1966). CMS does not respond to the CMS-2178.)

  • Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.

  • If the beneficiary does not receive a corrected card within that time, prepare another CMS-2178,annotate it “Follow-up,” and forward it to CMS.

4. MBR Incorrect/HI Incorrect

If both the MBR benefit name and the HI name are incorrect:

  • Prepare an SSA-3709. (This corrects the name in the benefit line of the MBR as well as the name in the HI record.)

  • If the name on the payment line of the MBR must also be corrected, notify the PC via an RC (SSA-5002). (The payment line name can be determined from the microfiche or benefit check.)

  • Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.

  • If a corrected card is not received within that time, request an HMQ.

    If HI record is correct, use HIC query procedures to generate a replacement card. (See SM 00706.035.)

    If both records are still incorrect:

    • Send the blue original and yellow copy of CMS-2178 to the servicing PC.

    • Indicate in “Correction Needed” block that SSA-3709 was transmitted but failed to correct records.

    NOTE: The PC advises the FO of action taken by completing the “Reviewing Office Reply” section of the CMS-2178.)

    • Request MBR and HI queries to verify that the MBR is corrected and the HI system is updated.

NOTE: The above procedures do not apply to name changes, only to corrections of misspelled names. If a name change due to remarriage, etc., is involved, see HI 00901.225B.

B. Procedure - Incorrect Sex

Send an HI/MBR Status Query (HMQ) (see SM 00706.005) or check the microfiche to see what sex code is in the MBR. The following describes the FO action necessary to correct incorrect sex codes as determined by the information contained in the query replies:

1. MBR Incorrect/HI Correct

If the MBR sex code is incorrect and the HI sex code is correct:

  • Prepare an SSA-3709.

  • If the MBR is still incorrect after 30 days,prepare an CMS-2178 annotated “Follow-up” and send it to the PC.

2. MBR Correct/HI Incorrect

If the MBR sex code is correct and the HI sex code is incorrect:

  • Prepare an CMS-2178. (See HI 00930.080.)

  • Forward the original (white copy) and a photocopy of the HI card, a photocopy of the microfiche, or the HI portion of the HMQ to CMS. (CMS corrects the HI master and issues a corrected card (CMS-1966). CMS does not respond to the CMS-2178.)

  • Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.

NOTE: If a corrected card is not received within that time, prepare another CMS-2178, annotate it “Follow-up,” and forward it to CMS.

3. MBR Incorrect/HI Incorrect

If both the MBR sex code and the HI sex code are incorrect:

  • Prepare an SSA-3709.

  • Tell the beneficiary to recontact the FO if a corrected