Medicare Mandatory Reporting
- Why are we asking for your Social Security Number?
- The SSN is used as the basis for the Medicare HICN. The Medicare program uses the HICN to identify Medicare beneficiaries receiving health care services, and to otherwise meet its administrative responsibilities to pay for health care and operate the Medicare program. In performance of these duties, Medicare is required to protect individual privacy and confidentiality in accordance with applicable laws, including the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act Privacy Rule. Please note that The Centers for Medicare & Medicaid Services (CMS) has a longstanding practice of requesting SSNs or HICNs for coordination of benefit purposes.
- The EIN is the standard unique employer identifier. It appears on the employee’s federal Internal Revenue Service Form W-2, Wage and Tax Statement received from their employer. The Medicare program uses the EIN to identify businesses. The establishment of a standard for a unique employer identifier was published in the May 31, 2002 Federal register, with a compliance date of July 30, 2004. A new Mandatory Insurer Reporting Law (Section 111 of Public Law 110-173) requires group health plan insurers, third party administrators, and plan administrators or fiduciaries of self-insured/self-administered group health plans to report, as directed by the Secretary of the Department of Health and Human Services, information that the Secretary requires for purposes of coordination of benefits. The law also imposes this same requirement on liability insurers (including self-insurers), no-fault insurers and workers’ compensation laws or plans. Two key elements that will be required to be reported are SSNs (or HICNs) and EINs. In order for Medicare to properly coordinate Medicare payments with other insurance and/or workers’ compensation benefits, Medicare relies on the collection of both the SSN or HICN and the EIN, as applicable.
This ALERT is to advise that collection of Social Security Numbers (SSNs), Medicare Health Insurance Claim Numbers (HICNs), or Employer Identification Numbers (EINs) for purposes of compliance with the reporting requirements under Section 111 of Public Law 100-173 is appropriate.
SSNs and EINs :
As a subscriber (or spouse or family member of a subscriber) to a group health plan arrangement, your SSN and/or HICN will likely be requested in order to meet the requirements of P.L. 110-173 if this information is not already on file with your insurer. Similarly, individuals who receive ongoing reimbursement for medical care through no-fault insurance or workers’ compensation or who receive a settlement, judgment or award from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation will be asked to furnish information concerning their SSN and/or HICN and whether or not they (or the injured party, if the settlement, judgment or award is based upon an injury to someone else) are Medicare beneficiaries. Employers, insurers, third party administrators, etc. will be asked for EINs.
To confirm that this ALERT is an official Government document and for further information on the mandatory reporting requirements under this law, please visit the CMS website at www.cms.hhs.gov/MandatoryInsRep.
Medicare Mandatory Reporting Requirements
Why do I need to provide you with my Social Security Number, Date of Birth, Gender and Legal Name when I make an injury claim?
- In 2007 president Bush signed into law the "Medicare, Medicaid and SCHIP Extension Act of 2007." This law, known as "Mandatory Insurer Reporting," establishes the requirement of all insurers and self insurers to report the settlement of all claims involving a Medicare eligible claimant to the federal government. In order to determine who is Medicare eligible, we need identifying information which includes the legal name, date of birth, gender and social security number. We require this information on all parties making a BI, UMBI, UIM, Med Pay or PIP claim.
Couldn’t I just advise you if I am eligible for Medicare or not?
- Unfortunately no. We are responsible for checking the Medicare eligibility of each party making an injury claim with the federal government ourselves.
What if I don’t feel comfortable providing my Social Security number to you?
Will you share my Social Security number with anyone?