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.