Technical Alert: CMS Sets a New Standard for Partial SSN Queries

CMS, Medicare Set-Aside Blog on June 19, 2015
Posted by Jessica M. Wingenroth, JD

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.

The full Technical Alert is available here.