Social Security Administration (SSA) Involvement

40.2 - Social Security Administration (SSA) Involvement (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) SSA maintains the Master Beneficiary Record (MBR) from which the Health Insurance (HI) Master Record is established. The CWF's eligibility record is accreted from this HI Master Record. The HI Master Record is updated periodically from a variety of sources, including the MBR, and in turn updates the Host maintaining the CWF record. However, errors occur where the MBR fails to correctly update the HI Master Record or where the HI Master Record fails to correctly update the CWF record. If the problem is caused by difficulties in determining the beneficiary's correct entitlement status, the A/B MAC or DME MAC must request assistance of the SSO. The SSO is responsible for processing the case. Examples of situations covered by this procedure are: • Problems involving Railroad Retirement Board (RRB) jurisdiction, i.e., the RRB has jurisdiction of the beneficiary's Medicare, and the claim was erroneously referred to the area A/B MAC (B); • Evidence that a beneficiary has utilization under more than one health insurance claim number (HICN), but the MAC is not aware of any cross-reference action taken by CMS; or • Assistance is needed to obtain or verify a beneficiary's name and/or MBI. (See specific procedures in §20.3.3.6 under disposition code 55.) In the event the SSO is unable to resolve the entitlement problem, e.g., a disposition code 55 is received after SSA verified the beneficiary's name and/or MBI, the MAC requests assistance from the RO. It includes complete details of the nature of the problem and a description of its efforts to resolve it.