SSA - POMS: HI 00901.245 - Correction of Health Insurance Cards - FO Action

A. Procedure - Misspelled given name or surname

Send a HI/MBR Status Query (HMQ) on the affected claim number, see SM 00706.005. Follow the FO action necessary to correct misspelled names as determined by the information contained in the query replies:

1. MBR Correct/HI Correct

If the MBR benefit name and the HI name are both correct, transmit a HIC to CMS, see SM 00706.025.

2. MBR Incorrect/HI Correct

If the MBR benefit name is incorrect and the HI name is correct,

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transmit a HIC query if a new card is needed.
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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.

3. MBR Correct/HI Incorrect

If the MBR benefit name is correct and the HI name is incorrect:

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Prepare an CMS-2178. see HI 00930.080.
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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.)
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Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.
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If the beneficiary does not receive a corrected card within that time, prepare another CMS-2178; annotate it “Follow-up,” and forward email it to CMS.

4. MBR Incorrect/HI Incorrect

If both the MBR benefit name and the HI name are incorrect:

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Use direct input, if possible Prepare an SSA-3709. This corrects the name in the benefit line of the MBR and the name in the HI record.
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If the name on the payment line of the MBR must also be corrected, notify the PC via an RC (SSA-5002). Determine the payment line name from the microfiche or benefit check.
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Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.
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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:
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  Email the blue original and yellow copy of CMS-2178 to the servicing PC.
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  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.

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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., see HI 00901.225B.

B. Procedure - Incorrect Sex

Send an HI/MBR Status Query (HMQ) (see SM 00706.005) or check the microfiche to see what sex code is in the MBR. Follow the FO action necessary to correct incorrect sex codes as determined by the information contained in the query replies:

1. MBR Incorrect/HI Correct

If the MBR sex code is incorrect and the HI sex code is correct:

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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.

2. MBR Correct/HI Incorrect

If the MBR sex code is correct and the HI sex code is incorrect:

•

Prepare an CMS-2178, see HI 00930.080.
•

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.
•

Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.

NOTE: If a corrected card is not received within that time, prepare another CMS-2178, annotated “Follow-up,” and email it to CMS.

3. MBR Incorrect/HI Incorrect

If both the MBR sex code and the HI sex code are incorrect:

•

Prepare an SSA-3709.
•

Tell the beneficiary to recontact the FO if a corrected card is not received within 30 days.
•
If a corrected card is not received within that time, request an HMQ.
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  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 a 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 records to verify that the MBR is corrected and the HI system is updated.

C. Procedure - Erroneous Claim Number: Reference

Send an HI/MBR Status Query (HMQ) on the erroneous number and the alleged correct number, see SM 00706.005.

When replies are received, follow the procedures for identification problems in HI 00910.050.

D. Procedure - Part B Entitlement Not Shown

If the beneficiary is insured and filed an initial application to establish HI after IEP and outside of a GEP, the beneficiary 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 to recontact the FO if it is not received by then.

E. Procedure - Erroneous Entitlement Dates

See HI 00930.001

Social Security

Program Operations Manual System (POMS)

HI 00901.245 Correction of Health Insurance Cards - FO Action