The DO has information that indicates that two different individuals (entitled to HI and/or SMI) are using the same social security number, that one of these individuals actually should be entitled on another number or not entitled at all, and that the wrong individual is reflected on the MBR for the number in question. They will explain what they believe are the facts in the case in the “Reason for Referral” portion of the referral form and attach any available proofs, etc. Upon receipt of the CMS-2178, the claims folder must be obtained and examined.

Almost all miscellaneous issues on the Form CMS-2178 may be completely processed by the Exceptions and Inquiries Examiner by following the instructions in this manual and in SM 00613.000 ff. Basically, the principle behind PSC completion and routing of the Form CMS-2178 remains the same as in all situations listed above.

If corrective action to the MBR and HIM is required, complete the “Reviewing Office Reply” portion of the CMS-2178 defining the data to be corrected. Send the blue original to the DO and file the yellow copy on the right side of the folder.

If no corrective action can be accomplished due to lack of proofs or an inaccurate allegation by the DO, explain the findings in the “Reviewing Office Reply” portion of the CMS-2178. Send the blue original to the DO and file the yellow copy on the right side of the folder.

If a final determination on the issue cannot be made by the Exceptions and Inquiries Examiner, prepare an interim reply to the DO and forward the folder to the appropriate module specialist for a determination. Request that person to expedite his/her determination and return the folder to the Exceptions and Inquiries Examiner after the determination is made. Depending upon the determination, follow the above instructions for completing and routing the Form CMS-2178.

In nearly all cited miscellaneous issues (items 2, 3, 4, and 8 of the Form CMS-2178), the MISCOR program may be used to correctly update the MBR. The rules set down in SM 00613.000 ff. should be used to effectuate each correction. The appropriate coding sheet should be prepared by the Exceptions and Inquiries Examiner and forwarded to the Data Entry operator per local instructions.

If full corrective action cannot be accomplished by using MISCOR, send the folder to a Benefit Authorizer and request that all required corrective action be taken. When the DO is requesting the status of an uninsured (T or M) claim refer to a Claims Authorizer for handling.

A very general key to the specific MISCOR change coding sheet to be used to effectuate changes requested via the CMS-2178 is shown below. Again, MISCOR can only be used when full correction can be accomplished by using that program.

Instructions for completing Forms SSA-2524, 2525, and 3621 can be found in SM 00613.000 ff.