The CMS-2178-U2 (see Exhibit HI 00930.090) is a one page, fillable form that the FO
or TSC can use to notify the PC and/or CMS, of needed corrections to both the MBR
and the health insurance record. It is also used to effect all changes on the Health
Insurance card (CMS-1966). These include misspelled given names or surnames and incorrect
sex, if direct input cannot be used (see HI 00901.245). You can use the CMS-2178-U2 for entitlement issues, which cannot be correct by
direct input, but not for routine premium issues.
Before using the form CMS-2178-U2 process, you should consider the use of direct input
facilities such as the Post Entitlement Online System (POS).
If the sex codes or name on both the MBR and HI Master are incorrect, it can be corrected
by updating the information via the POS. This action will subsequently update the
Enrollment Data Base (EDB).
Date of Death – If the MBR and HI Master are incorrect, it can be corrected by updating
the information via the Death Information Processing System (DIPS
Also, if a state buy-in problem exists do not use Form CMS-2178-U2. Instead, use Form
CMS-1957, (See HI 00815.088.)