HI 00930.060 Problem Correction Process

A. If Both the MBR and Health Insurance Master are Incorrect

Refer the form CMS-2178 (HIB/SMIB Entitlement Problem - Priority) to the appropriate Processing Center (PC). If the documentation agrees with the DO request, the Exceptions and Inquiries Examiner will take action to correct the MBR and will advise the DO of the action taken by completing the “Reviewing Office Reply” portion of the CMS-2178.

The PC will no longer send the CMS-2178 to CMS"s Bureau of Support Services (BSS) for correction of the health insurance record. The MBR correction should update the health insurance master and both records should be corrected within 30 days of the date of the PC action to correct. The DO must query the MBR and HI record to determine if the corrections have processed. If the MBR is still wrong 30 working days after the date of the PC action, see the procedures for followup action in HI 00930.070. If the HI record only is still incorrect, follow the procedures in section B below.

In situations where the beneficiary"s name is spelled incorrectly or the sex code is incorrect on both the MBR and the Health Insurance master, use direct input (see SM 00706.265, Exhibit W).

B. If Health Insurance Master Only Is Incorrect

The DO referral is to CMS/BSS. BSS notifies the DO when the health insurance master has been corrected by completing the “CMS/BSS Reply” section of the CMS-2178. The DO must verify the correction by requesting an ESQ.

EXCEPTION:

Health Insurance record problems dealing with Health Maintenance Organization (HMO) indicators or United Mine Workers of America (UMWA) jurisdiction coding should be directed to the appropriate CMS Regional Office at the address given in HI 00930.070D. Do not use the CMS-2178 for these coding problems.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600930060
HI 00930.060 - Problem Correction Process - 05/13/2008
Batch run: 01/27/2009
Rev:05/13/2008