CMS Updates Model Language Form for SSN/MBI Information

CMS, Medicare Set-Aside Blog on April 16, 2021
Posted by Shannon Flynn

by Frank Fairchok, Vice President of Medicare Reporting Services

This week, CMS released an updated form to help Non-Group Health Plan (NGHP) Responsible Reporting Entities (RRE) with model language around the collection of Social Security Numbers (SSN) or Medicare Beneficiary Identifiers (MBI).

The images below highlight the changes (click each image for a close-up view).


The updates to the form include several minor changes that are likely being made for expanding recovery processes with Medicare Advantage Plans (Part C) and prescription drug plans (Part D) providers. This is in conjunction with upcoming, yet still technically undefined, update to the query process in compliance with the PAID Act (H.R. 8900) that was signed into law December 11, 2020.

Under the PAID Act, CMS will need to modify the query process to include the Part C and D plan information in which the beneficiary was enrolled in during the previous three years from date of query. MEDVAL recommends updating your procedures with the amended form as we await further guidance on the evolving query process. You can download a copy of the updated form here.