SSO Assistance in Resolving Entitlement Status Problems

70 - SSO Assistance in Resolving Entitlement Status Problems (Rev. 4247, Issued: 03-01-19, Effective: 04-01-19, Implementation: 04-01 -19) The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes. A. Social Security Office (SSO) Assistance The A/B MAC (A), (B), or (HHH), or DME MAC directs initial requests for assistance to the SSO if the problem is caused by difficulties in determining the beneficiary’s correct entitlement status. Examples of situations that may require SSO assistance are: • Problems involving Railroad Retirement Board (RRB) jurisdiction; • Evidence that a beneficiary has utilization under more than one Medicare beneficiary identifier but there is no awareness of any cross-reference action taken by CMS; or • The beneficiary’s name, address, sex code, date of birth, or date of death is incorrect on the HI master record. In the event the SSO is unable to resolve the entitlement problem (e.g., cross referencing of HI records), the MAC requests assistance from the RO.