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 the Medicare card and it is a new entitlement
case, follow this procedure:
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1.
Request an abbreviated Account Query (AACT).
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2.
Determine whether it is time to follow up:
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automatic enrollment and card not received by the end of the 1st month of the Initial
Enrollment Period (IEP), or
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beneficiary lives in Puerto Rico or outside the U.S. and 4 weeks elapsed since the
FO input the CMS-40B enrollment form, or
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domestic initial claim was processed more than 2 weeks ago. Are the time-frames met?
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If no, review all important and inform the beneficiary when they should be receiving the
Medicare card. Advise the beneficiary to re-contact the FO if the card is not received
by then.
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3.
Does the AACT show Hospital Insurance (HI) and or SMI entitlement?
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If no, send and MDW to the payment center (PC) STOP.
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4.
Request a HI/SMI Query Response (HIQR). Does the CMS DATA show HI and or SMI entitlement?
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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
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5.
Press Enter on QRHI to retrieve the ADDR screen. Follow this procedure.
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If the address is ....
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Then
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correct on both SSA and CMS records
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go to step 6.
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incorrect on the Master Beneficiary Record (MBR)
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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.
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input Health Insurance Replacement Card (HCRQ).
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advise the beneficiary the card should be received in 2 weeks.
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correct on the MBR but incorrect on CMS records
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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.)
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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 00930.005.
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6.
Does the QHRI show a MEDICARE CARD ISSUED date within the last 14 days?
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If yes, advise the beneficiary of receipt of a Medicare card is 2 weeks from date MEDICARE
CARD ISSUED.
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If no:
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input Health Insurance Replacement Card (HCRQ)
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advise the beneficiary the Medicare card should be received in 2 weeks
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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 for the next replacement Medicare card. Explain the advantages
of the online and automated services, which allows user to submit a request quickly
and without a wait to speak to an SSA representative.