Identification Number:
HI 00930 TN 6
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Resolving Entitlement Problems
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 009 – Evidence of Entitlement
Subchapter 30 – Resolving Entitlement Problems
Transmittal No. 6, 06/25/2021

Audience

OCO-OEIO: CAQCR, CR, CR TII, DRT, EIE, FR, OA, OS, PETL, RR, SR, TA, TE, TSC-SR;
OCO-ODO: BTE, CST, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal and no change to policy and procedure.

Summary of Changes

HI 00930.080 Completion and Use of the CMS-2178-U2 (HIB/SMIB Entitlement Problem — Priority)

Updated POMS with PDF attachment and revised language in the chart.

HI 00930.080 Completion and Use of the CMS-2178-U2 (HIB/SMIB Entitlement Problem — Priority)

A. Use of the CMS-2178-U2

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.)

B. Completing the CMS-2178-U2

A fillable form CMS-2178 U2 is available by clicking on the PDF document below:

  1. 1. 

    If both MBR and HI records are incorrect, attempt to correct the address via POS or send a CMS-2178-U2 to the PC of jurisdiction via paperless. If HI record only is incorrect, send a CMS-2178-U2 to CMS via email to 2178Mailbox@cms.hhs.gov

  2. 2. 

    “From” block: Enter the complete FO mailing address, including the ZIP code. Enter the FO code in space provided. Indicate name and phone number (include area code) of person in FO to be contacted if additional information is needed. Also, annotate the office email address and phone number.

  3. 3. 

    In the appropriate space in the upper left hand corner, enter the date you email the form to CMS.

  4. 4. 

    Enter the beneficiary’s claim number, and, if applicable, any related RRB or SSA claim number.

  5. 5. 

    Enter the beneficiary’s name, address, and telephone number in the spaces provided.

  6. 6. 

    Check whether the CMS-2178-U2 is an “Original Request” or “Followup.”

  7. 7. 

    Reason for Referral:

    • Attach any documentation, e.g., SSA-250, establishing the fact and date of filing of the CMS-40B

    • Be sure to consider the direct input capabilities which exist for name, sex code, and death corrections (HI 00930.080A). Failure to use direct input when possible will delay the correction process unnecessarily.

    • Attach screenshots of pertinent MBR and HI printouts for all numbers involved.

    • Use the space provided to explain the problem situation as precisely as possible.

8. Correction Needed:

State clearly what the final result of the correction should be, i.e., how the MBR and HI record should look if accurate entitlement information is entered. Attach the documentation available to support any change.

C. Routing of the CMS-2178-U2

Use the form CMS-2178-U2 to refer all Medicare entitlement problems to the PC or CMS. It should be used to report date of death problems when direct input cannot be used. Do not use the SSA-5002 to report needed death corrections.

  1. 1. 

    When initially referring the form, check the appropriate block in the “Routing of Referral” section and the address section. . Email the form to the PC or CMS, as appropriate. Maintain a copy in NDRED. For referrals to CMS Central Office uses 2178Mailbox@cms.hhs.gov. For referrals to CMS Regional Offices, use the appropriat emal by clicking on this link: CMS- Regional Office .

  2. 2. 

    The PC or CMS will send a response back to the email address(es) you annotated on the form.

  3. 3. 

    When follow-up referrals to the PC or CMS are necessary (HI 00930.070), send a second email with the proper follow-up blocks checked.

  4. 4. 

    When referral to the CMS Associate Regional Administrator for Program Operations is necessary (HI 00930.070 D), email a copy of the form to document actions previously taken. For appropriate CMS RO email addresses, please click on this link: CMS-Regional Office.

D. Chart of Basic Problem Situations Requiring HI Entitlement Corrections (For Critical Case Procedure, see HI 00930.110.) (For RR Involvement, see HI 00901.165.)

 

INCLUDE CURRENT MBR AND HI QUERY REPLIES WITH ALL REFERRALS (INITIAL AND FOLLOWUP).

1. ENTITLEMENT PROBLEM

a. MBR (only) or Both MBR and HI Record Incorrect

 

 

 

Initial Action Follow-up Procedure Final Follow-up
If the corrective actions cannot be resolved via POS. Send the CMS-2178-U2 via Paperless to the servicing PC. The PC technician will take action to correct the MBR and will advise the FO of action taken by completing the " Reviewing Office Reply section of the CMS-2178-U2. MBR and HI queries should be requested to verify that the MBR is corrected and has updated the HI system. No reply from PC within 30 working days of the CMS-2178-U2 referral; or MBR is still incorrect 30 working days after PC took corrective action. Send a follow-up to PC via an Modernized Development Worksheet (MDW). No reply within 30 working days of a follow-up; or problem is not corrected within 90 calendar days of initial CMS-2178-U2 referral: Send an email to the appropriate CMS RO. Include a copy of the CMS- 2178-U2 to document actions taken. Click on link : CMS Regional Officesfor email addresses.

b. HI Record (Only) Incorrect

 

 

 

Initial Action Follow-up Procedure Final Follow-up
Send an email to CMS with the CMS 2178-U2 attached. CMS will notify the FO when they take an action to correct the HI master. Verify the correction by requestin an ESQ. No reply from CMS within 30 working days of the CMS-2178 U2 referral; or HI record is still incorrect after CMS took corrective action: You should send an email to CMS indicating follow up with a copy of the CMS-2178 U2 to CMS. Check 30 Day follow up block. In "Correction Needed" section indicate either "No reply received to original CMS 2178 dated". Verify action indicated in your reply dated. HI record still incorrect". No reply within 30 working days of a follow-up; or: problem is not corrected within 90 calendar days of initial CMS-2178-U2 referral: Send an email to the appropriate CMS RO. Include a copy of CMS-2178 to document the action taken. Click on link: CMS Regional- Offices for email addresses

2. NAME/SEX CODE PROBLEM

a. Both MBR and HI Record Incorrect

 

 

 

Initial Action Follow-up Action Final Follow-up
.Use direct input. 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 Post Entitlement Online System (POS) Beneficiary has not received a correct HI card after 30 working days: Request an HMQ. If HI record is correct, use HIC query procedures to generate a replacement HI card (See SM 00706.035). If both records are still incorrect, send a CMS-2178 to the servicing PC via paperless. Corrected HI card not received within 30 working days of a follow-up. Send an email to the appropriate CMS RO. Click on link: CMS Regional Officesfor email addresses. Please include a copy of the CMS-2178-U2 to document actions taken.

b. HI Record (Only) Incorrect

 

 

 

Initial Action Follow-up Action Final Follow-up
.Send an email to CMS with the CMS-2178-U2 attached. CMS will notify the FO when they take an action to correct the HI master. Verify the correction by requesting an ESQ. No reply from CMS within 30 working days of th-U2 referral; or: HI record is still incorrect after CMS took corrective action: You should send an email to CMS. Check “30 Day Follow-up” block. In “Correction Needed” Section indicate either: “No reply received to original CMS-2178 dated .” or: “Verify action indicated in your reply dated . HI record is still incorrect." Corrected HI card is not received within 30 working days of follow-up: Refer problem to the appropriate CMS Regional Office. Include a copy of the CMS-2178-U2 to document actions taken. Click on link: CMS Regional Offices for email addresses.

c. MBR (Only) Incorrect

 

 

 

Initial Action Follow-up Action Final Follow-up
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 Post Entitlement Online System (POS) MBR not corrected after 30 working days: Send a CMS-2178-U2 to the servicing PC via paperless. No reply within 30 working days or MBR still incorrect 30 working days after PC took corrective action: Send an email to the appropriate CMS Regional Office. Include a copy of the CMS-2178 to document actions taken. Click on link: CMS Regional Offices for email addresses.

3. DATE/FACT OF DEATH DISCREPANCY (SEE SM 00706.075 ff.)

a. Both MBR and HI Record Incorrect

  1. 1. 

    Only Day of Death Wrong

 

 

 

Initial Action Follow-up Procedure Final Follow-up

If the MBR and HI Master are incorrect, it can be corrected by updating the information via the Death Information Processing System ( DIPS).

If day of death correction has not processed, verify original input. If error, resubmit with correct data. If no error in transmission found, fax the CMS-2178 via Paperless to the servicing PC. Include the HMQ replies and documentary Request HMQ replies on the 20th working day following email release of CMS-2178-U2 to the PC. If the day of death is still wrong, email the problem to the CMS Regional Office. Include a copy of the CMS-2178 to document actions taken. Click on link: CMS Regional Offices for email addresses.
  1. 2. 

    Month and/or Year Wrong or Date of Death Should Be Removed

 

 

 

Initial Action Follow-up Procedure Final Follow-up
If the MBR and HI Master are incorrect, it can be corrected by updating the information via the Death Information Processing System (DIPS). Request HMQ replies on the 20th working day following release of CMS-2178-U2. If still wrong, send a CMS-2178-U2 with the “follow-up” box checked to the PC via Paperless. .Request HMQ replies on the 20th working day following date of followup to PC. If records still wrong, email the CMS-2178-U2 to the appropriate CMS Regional Office. Click on link: CMS Regional Offices for email addresses.

b. HI Record (Only) Incorrect (To Change or Remove)

  1. 1. 

    Date of Death Not Proven

 

 

 

Initial Action Follow-up Procedure Final Follow-up
Use direct input where possible. If direct input fails, follow 2 below.
  1. 2. 

    Date of Death Proven

 

 

 

Initial Action Follow-up Procedure Final Follow-up
Send an email to CMS with a copy of the CMS-2178 U2. Include screenshots of HMQ replies and documentary evidence. No reply form CMS within 30 working days of the CMS-2178-U2 referral; or HI record is still incorrect after CMS took Corrective action; then send an email marked "Follow-up Copy to CMS." Check “30 Day Follow-up” block. In “Correction Needed” section indicate either: “No reply received to original CMS-2178 dated .” or: “Verify action indicated in your reply dated . HI record is still incorrect.” n. No reply within 30 working days of a follow-up. Send an email to the appropriate CMS Regional Office. Click on link: CMS Regional Offices for email addresses.

HI 00930 TN 6 - Resolving Entitlement Problems - 6/25/2021