HI 00930.020 Beneficiary Dually Entitled to B and D4 Benefits

To determine which Medicare Number is the active Medicare Number, send a HMQ query (see SM 00706.005) on both Medicare Numbers and observe the following when the query replies are received.

A. B Medicare Number Active

The MBR reply on the B Medicare Number has a LAF code of C (current pay) with full HI/SMI entitlement data. The MBR reply on the D4 Medicare Number reflects the combined payment status by having a LAF code of AD.

B. D4 Medicare Number Active

The MBR reply on the D4 Medicare Number reflects the separate payment status by having LAF code other than AD (LAF code will probably be C) and shows full HI/SMI entitlement data.

The instances of finding the B Medicare Number as the active number are diminishing. Present policy is to make the D4 the active Medicare Number in all cases. Prior to this policy decision, however, HI/SMI entitlement was awarded on either the B or D4 depending on the payment of benefits.

If the beneficiary has a Medicare card under both the D4 and B Medicare Numbers, the Medicare card under the inactive Medicare Number should be recovered in accordance with HI 00901.185. The query reply on the inactive SSN, determined from the MBR reply as described above, should have a cross-referenced (XCN) followed by the active number. If the health insurance master reply shows that the B and D4 Medicare Numbers are not properly cross-referred, refer the problem to CMS.


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HI 00930.020 - Beneficiary Dually Entitled to B and D4 Benefits - 04/24/2018
Batch run: 04/24/2018
Rev:04/24/2018