UPDATE: CMS Accepts 5 digit SSNs

UPDATE: CMS Accepts 5 digit SSNs
|Legal News, Medicare News, Medicare Secondary Payer – Information and Services for RREs/Primary Payers, Medicare Secondary Payer- Information and Services for Plaintiffs’ Counsel & Beneficiaries

In further implementation of the SMART Act, on January 5th, 2015 CMS released the latest version of the MMSEA Section 111 NGHP User Guide. The changes were expected, and are welcomed. The 2 major changes to the user guide are outlined below:

1) CMS will now accept 5 digit SSN’s on submitted records. RREs that submit query and claim input files may now enter SSN’s with 4 leading spaces. DDE clients only need to type in the last 5 and do not need to enter the leading spaces. To accommodate this change CMS has updated the Disposition Codes to include DP (used for identifying duplicates), Disposition Code 51 has been slightly modified, and the beneficiary matching logic has been modified. Taken directly from the user guide:

a. The beneficiary matching logic has been changed. First, an exact match on the HICN or SSN entered (either the last 5 digits or full 9 digits) must be found. Then, at least three of the four remaining data elements (listed below) must be exactly matched to the individual:

First initial of the first name
First six characters of the last name
Date of Birth (DOB)
Gender

View the Technical Alert regarding Reporting Partial SSNs:

Technical-Alert-Reporting-Partial-SSNs - PDF

 

Please contact us directly if you have additional questions.

Best,
Seana

About the author

Seana B. Thomas

Founder and Principal Attorney, Seana Thomas is a recognized authority on Medicare Secondary Payer law (MSP) and procedure, and has been a civil litigator in California for over 25 years. Since 2008, Ms. Thomas has been involved in the analysis and understanding of issues relating to the existing Medicare Secondary Payer reimbursement system, current and anticipated revisions in MSP law and procedure in the liability context, and the effect they have on the rights and obligations of "primary payers" (RREs), beneficiaries and their counsel in liability claims or lawsuits asserted by a Medicare beneficiary.

In the summer of 2008 she was co-author, with Roy Franco, J.D. and David Rosenbaum, Esq., of a detailed analysis of the Medicare statutory reimbursement system and issues it presents for RREs and beneficiaries in the liability context in response to a Request for Comment regarding proposed changes to the MSP. This 100-plus page analysis was entered into the United States Congressional Record. Since then, MSP law and procedure has been a significant focus of Ms. Thomas's practice. Ms. Thomas continues an active civil litigation practice through trial and appeal for defense entities and plaintiffs. References are available upon request.

Tarfoot Consulting, Santa Barbara, California
Website Design by Tarfoot Consulting, Santa Barbara, California.