Technical Alert: CMS Sets a New Standard for Partial SSN Queries
CMS has changed the criteria for matching Medicare beneficiaries on an NGHP Mandatory Insurer Reporting Query, but only if a partial SSN has been entered.
Effective immediately, when a partial SSN is submitted for query, all five data elements must produce an exact match to a Medicare beneficiary for a result to be returned. Alternatively, if a full SSN is submitted then there is less scruitiny and only three of the four remaining data elements are required to return a match.
This change nudges RREs toward submitting a full SSN when it is available, which CMS states is encouraged to ensure accuracy.