It has come to CMS’ attention that in some instances, MMPs are submitting a Medicaid Identification Number (e.g. MSIS ID) in lieu of the required Medicare Health Insurance Claim Number (HICN) as the beneficiary’s/subscriber’s identification number. This notice is to serve as a reminder that CMS requires the Medicare HICN in ALL Encounter Data submissions by MMPs, in the 837 Medicare and Medicaid submissions along with the Medicaid NCPDPs.
An MMP has the option to place a Medicaid State Assigned Beneficiary Identification Number in an alternate location found in the 2010BB REF02 G2 segment (837).
However, only the Medicare HICN may be located in loop 2010BA NM109 [Subscriber Primary Identifier], which must match the value in loop 2330A, NM109.
Only the Medicare HICN may be populated in the NCPDP’s Field #267 [Insurance Code].
If an MMP has submitted Medicaid Encounter Data to CMS using a Medicaid or other ID instead of the Medicare HICN in the past, the MMP should NOT resubmit corrected data. Instead the MMP should ensure that any future submissions contain the Medicare HICN as primary beneficiary’s/subscriber’s identifier.
In the event you have questions, please contact CSSC Operations at 1-877-534-2772 (option 2) or by email at csscoperations@palmettogba.com.