CMS Alert: Matching Criteria for SSNs


On June 18, 2015, CMS issued an Alert entitled "Modification of Matching Criteria Used When Reporting Partial Social Security Numbers for Liability Insurance (Including Self-Insurance), No Fault Insurance, and Workers’ Compensation." The text of that alert is copied below:

New Matching Criteria for Partial SSNs

In order to determine if individuals are Medicare beneficiaries, the following information is used:

•HICN or SSN

•First initial of the first name

•First 6 characters of the last name

•Date of birth (DOB)

•Gender

Effective immediately, the matching criteria for partial SSNs will be changed. When an exact match on the partial SSN is found, then four out of the four remaining data elements must be matched to the individual exactly. The matching criteria for HICNs and full SSNs will remain the same.

Reporting Compliance Considerations

NGHP RREs are encouraged to submit the HICN or full SSN when available to ensure the most accurate match is attained. Failure to match to a Medicare beneficiary with the full or partial SSN does not negate the RRE's Section 111 mandatory reporting requirement when a reportable claim exists. The entire alert can be found here.

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