CMS Updates MMSEA Section 111 User Guide
Roy Franco
April 9, 2015

CMS released yesterday version 4.6 of the MMSEA Section 111 User Guide, dated April 6, 2015. Responsible Reporting Entities (RREs) when encountering instances of the disposition code “DP” for possible duplicate beneficiary situations, are instructed on what actions to take to remain in compliance. The new disposition code was added because of the SMART legislation which required CMS to curtail the use of Social Security Numbers (SSN) and/or Health Identification Claim Numbers (HICN) by RREs to identify Medicare status. The rationale was to protect the beneficiary’s privacy and as a result CMS implemented a system which allowed RREs after January 5, 2015 to query for Medicare beneficiary status with the last five digits of the claimant’s SSN. This new procedure allows for scenarios where more than one beneficiary could be identified, and the “DP” code is to alert the RRE of that possibility. The new User Guide now outlines the steps that the RRE must take to remain in compliance with their responsibility to identify Medicare status under the MSP law.

Chapters IV and V, of the User Guide details the additional steps the RRE must take to meet compliance requirements. In such instances the RRE must: 1) Verify that the SSN, name, gender and date of birth were entered accurately and re-submit; 2) Enter the full 9-digit SSN (if available) and re-submit. If after these attempts the “DP” code is still returned, the RRE must contact the BCRC at 1-855-798-2627 to file a self-report. No instructions are provided to the RRE on how to complete the reporting responsibilities if the self-report is accepted, as presumably the MMSEA Section 111 data would still show no match and be an impossibility to report ORM, ORM Termination or TPOC. As your reporting agent we will seek clarification from CMS with respect to this potential conflict in the data and apprise.