PROGRAM OPERATIONS MANUAL SYSTEMPart HI – Health InsuranceChapter 009 – Evidence of EntitlementSubchapter 01 – Hospital Insurance EntitlementTransmittal No. 6, 06/23/2021
This is a Quick Action Transmittal and no change to policy or procedure.
Summary of Changes
HI 00901.245 Correction of Health Insurance Cards - FO Action
Made changes to email addresses, removed bullets, and added references.
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:
If the MBR benefit name and the HI name are both correct, transmit a HIC to CMS. (See SM 00706.025.)
If the MBR benefit name is incorrect and the HI name is correct:
Transmit a HIC query if a new card is needed.
Use direct input, if possible 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.
If the MBR benefit name is correct and the HI name is incorrect:
Prepare an CMS-2178. (See HI 00930.080.)
F Email the completed CMS-2178 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, check annotate it “Follow-up,” and forward email it to CMS.
If both the MBR benefit name and the HI name are incorrect:
Use direct input, if possible 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.)
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:
Email 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.
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:
If the MBR sex code is incorrect and the HI sex code is correct:
Use direct input if possible
If the MBR is still incorrect after 30 days,prepare an CMS-2178 annotated “Follow-up” and send it to the PC.
If the MBR sex code is correct and the HI sex code is incorrect:
Email the completed CMS-2178 to CMS (CMS corrects the HI master and issues a corrected card (CMS-1966). CMS does not respond to the CMS-2178.)
NOTE: If a corrected card is not received within that time, prepare another CMS-2178, annotate it “Follow-up,” and email it to CMS.
If both the MBR sex code and the HI sex code are incorrect:
Prepare an SSA-3709.
Email a copy of CMS-2178 to the servicing PC.
Request MBR and HI records to verify that the MBR is corrected and the HI system is updated.
Send an HI/MBR Status Query (HMQ) (see SM 00706.005) on the erroneous number and the alleged correct number.
When replies are received, follow the procedures for identification problems in HI 00910.050.
If the beneficiary is insured and filed an initial application to establish HI after his/her IEP and outside of a GEP, (s)he is “deemed” automatically enrolled for Part B in the next GEP. Since Part B enrollment could be prospective for up to 15 months,an initial Part A-only card is released. (The HMQ reply reflects the prospective Part B coverage.) The following January, a new card is automatically released which reflects the addition of Part B coverage.
If this situation does not apply, and the beneficiary"s enrollment was submitted at least 6 weeks earlier, follow the procedures in HI 00930.001.
If 6 weeks has not elapsed, inform the beneficiary when to expect to receive a new card and advise him/her to recontact the FO if it is not received by then.
See HI 00930.001ff.