TN 49 (11-22)

HI 01001.250 Addition of Persons to Group Billing Account

The initial premium notice in all cases will be sent to the enrollee. An enrollee who wishes to have their premiums paid by a group willing to pay them will, by prearrangement, turn their premium billing notice over to the organization along with the enrollee's authorization for CMS to bill the group for their premiums thereafter, and to release the minimum of information required for a group billing arrangement. The organization, if a nongovernmental entity, forwards all authorizations, premium notices, and payments covering the total premiums shown on such notices to:

CMS
BSS, Division of Operations
Group Billing Audit and Billing Section
P.O. Box 11977
Baltimore, Md. 21207

If the organization is a governmental entity, it may retain that authorizations and forward to the Administration premium notices, payments, and a certification that it maintains an authorization in its files for each enrollee for whom it makes payment.

A separate premium billing record (the third-party master file) is maintained in BSS from which group premium payers are billed. This record is the basic group premium collection control record. Once the group account has furnished the premium billing notices to BSS, appropriate data is added to the third-party master file and billing to the group is initiated.

The third-party master record is updated monthly, beginning in about the 25th of the month. After the third-party master file is updated to reflect current changes, records are furnished to the SSA post-entitlement system for annotation of the MBR and Third Party Records. When group payment data is annotated to the MBR, a systems generated letter will be sent to the beneficiary. In addition, data to prepare an SSA-1596 C1 (Record of Change in Premium Deduction or Billing Status) is forwarded to the PSC for folder documentation of group billing status and documentation that appropriate authorization has been received. Direct premium billing to the individual will be discontinued with the next bill or followup schedule for release after the MBR and Third Party Records are annotated, e.g., group billing accretions received and processed by OIS on April 25, third-party operations will result in discontinuance of direct billing to individuals in the selection of billing items for June (July 5 due dates).