PROGRAM OPERATIONS MANUAL SYSTEMPart HI – Health InsuranceChapter 009 – Evidence of EntitlementSubchapter 01 – Hospital Insurance EntitlementTransmittal No. 4, 02/07/2019
Individuals normally receive a Medicare award notice and Medicare card within 2 weeks after SSA processes their claim or post entitlement enrollment request during the IEP/SEP/GEP. SSA issues the “Temporary Notice of HI-SMI Eligibility” in the rare instance that an individual meets all the requirements for initial Medicare entitlement, but needs urgent health care prior to receiving his or her Medicare award notice or Medicare card.
SSA will no longer issue the Temporary Notice of HI-SMI Eligibility because systems enhancements now allow beneficiaries to obtain their Medicare Number within 24 hours after SSA processes their claim. A beneficiary will have access to his or her Medicare Number for sharing with medical providers if healthcare services are needed prior to the Medicare card arriving.
Summary of Changes
HI 00901.225 Health Insurance Card Inquiries - Allegation of Nonreceipt and FO Action
We changed the title to “Medicare Card Inquiries – Non-receipt of Medicare Card and Field Office (FO) Action.” We revised step 1 under section A.1 (“New Claims Case”) to accurately reflect the proper system used in FOs. We revised the steps under section A.2 (“Post-Entitlement Cases”) because we will no longer issue the Temporary Notice of HI-SMI Eligibility.
A beneficiary can expect to receive their Medicare card within 2 weeks after the SSA processes their initial claim or postentitlement enrollment request. If the Railroad Retirement Board (RRB) has jurisdiction, refer the caller to RRB at 1-877-772-5772.A Medicare Beneficiary Identifier (MBI) is assigned for all new entitlement effective April 2018. All other beneficiaries will be issued a new card with the MBI in phases, which should be completed by 5/1/2019. Beneficiaries can obtain their MBI over the phone when proof of identity is provided or online with an established mySocial Security account, 24 hours after SSA establishes the entitlement. Beneficiaries should be encouraged to register for an account at mysocialsecurity . Use the following procedures to handle non-receipt of Medicare cards for new entitlement and postentitlement cases.
New entitlement cases are those where a beneficiary has recently filed for Medicare, recently became entitled to Medicare or has become re-entitled to Medicare benefits.
If a beneficiary states they did not receive their Medicare card and it is a new entitlement case, follow this procedure:
Request an abbreviated Account Query (AACT).
Determine whether it is time to follow up:
automatic enrollment and card not received by the end of the 1st month of the Initial Enrollment Period (IEP), or
beneficiary lives in Puerto Rico or outside the U.S. and 4 weeks have elapsed since the field office (FO) input the CMS-40B enrollment form, or
domestic initial claim was processed more than 2 weeks ago. Are the time-frames above met?
If yes, go to step 3.
If no, review all important and inform the beneficiary when they should be receiving their Medicare card. Advise him or her to re-contact the FO if the card is not received by then.
Does the AACT show Hospital Insurance (HI) and/or SMI entitlement?
If yes, go to step 4
If no, send and MDW to the payment center (PC) STOP.
Request a HI/SMI Query Response (HIQR). Does the CMS DATA show HI and/or SMI entitlement?
If yes, go to step 5.
If no, MDW to the payment center (PC) to force an interface and then determine if a CMS-2178-U2 to CMS RO is appropriate (see HI 00930.005). STOP
Press Enter on QRHI to retrieve the ADDR screen. Follow this procedure.
If the address is ....
correct on both SSA and CMS records
go to step 6.
incorrect on the MBR (Master Beneficiary Record)
complete the POS Address/Direct Deposit/Phone Change of Address (PEAD) screen to correct the MBR. If SSI is involved, also process the SSI change of address.
input Health Insurance Replacement Card (HCRQ).
advise the beneficiary that the card should be received in 2 weeks.
correct on the MBR but incorrect on CMS records
input Health Insurance Replacement Card (HCRQ). On HCRQ, retype some part of the address (e.g., the 2-letter state code). (This will cause the system to send the correct address to CMS for the Medicare card, but it will not update CMS records.)
If no , send an MDW to the payment center (PC) to force an interface and then determine if a CMS-2178-U2 to CMS RO is appropriate (see HI
Does the QHRI show a MEDICARE CARD ISSUED date within the last 14 days?
If yes, advise the beneficiary that he or she will receive a Medicare card 2 weeks from the MEDICARE CARD ISSUED date.
input Health Insurance Replacement Card (HCRQ)
advise the beneficiary that the Medicare card should be received in 2 weeks
inform the beneficiary that SSA provides this service online and through an automated service on our National 800 Number. Encourage the caller to consider using one of these service options the next time he or she needs a replacement Medicare card. Explain the advantages of the online and automated, services which allows user to submit their request quickly, and without having to wait to speak to an SSA representative.
HI 00901.085 New Entitlement Cases- Card Issuance
HI 00930.005 Revised Form CMS-2178US (HI/SMI Entitlement Problem Referral)