Beneficiary Beneficiary is a category in PRS 2.0 where users can search and view for beneficiary information. The users can view the beneficiary details, coverage information, cross reference information and entitlement reason when they access the beneficiary module The Beneficiary module links to BIC (beneficiary information on cloud) via their APIs. The beneficiary data is available real time in PRS 2.0 Users can search for a beneficiary using MBI, HCIN, SSN or RRB via basic search. You can also search for the beneficiary using the advanced search by a combination of the below fields First name, last name, state First name, last name, birth date First name, last name, zip code The first name can be partial match. Beneficiary details Address 1 - 6 The mailing address where the beneficiary or the beneficiary's representative payee can be contacted. There are six address lines. Birth Date The birth date of the beneficiary. City The name of the city for the listed address. Claim Account Number (CAN) Number that identifies the primary Medicare beneficiary under the Social Security Administration (SSA) or Railroad Retirement Board (RRB) programs. This number along with the Beneficiary Identification Code (BIC) uniquely identifies a Medicare beneficiary. County Number The code for the county of residence for the beneficiary. Death Date The date of the beneficiary's death. Extension The telephone extension number for the beneficiary. First Name The first name of the Medicare Beneficiary. Gender The sex of the beneficiary. Key | Description | 0 | Unknown | 1 | Male | 2 | Female |
Health Insurance Claim Number (HICN) The Health Insurance Claim Number (HICN) is a Medicare beneficiary's identification number, used for paying claims and for determining eligibility for services across multiple entities (e.g. Social Security Administration (SSA), Railroad Retirement Board (RRB), States, Medicare providers and health plans, etc.) Last Name The last name of the Medicare beneficiary including any following titles. Middle Name The first position (letter) of a beneficiary's middle name. Medicare Beneficiary Identifier (MBI) Under the Social Security Number Removal Initiative (SSNRI), SSNs are being removed from all Medicare cards. A new Medicare Beneficiary Identifier (MBI), which uniquely identifies a Medicare beneficiary, is replacing the SSN-based Health Insurance Claim Number (HICN) on new Medicare cards being issued by CMS. The MBI is a randomly generated identifier that does not include a social security number or any personally identifiable information (PII). It is visibly different from the HICN and Railroad Retirement Board (RRB) numbers. The MBI is 11-characters in length and made up only of numbers and uppercase letters (no special characters), in a specified format. Primary Payer Code A code that indicates which other federal programs or insurance sources are required by law to pay their share of a Medicare beneficiary's medical claims before CMS funds can be used. These insurance sources are called 'primary payers'. When a Beneficiary has a primary payer, CMS becomes the 'secondary payer' of Medicare claims. Note: Values C, M, N, Y, Z and BLANK indicate Medicare is primary payer Key | Description |
| Medicare is Primary Payer | 1 | Potential Workers' Compensation | 2 | Potential Black Lung | 3 | Potential Department of Veterans Affairs | A | Working aged Bene/spouse with employer group health plan (EGHP) | B | End Stage Renal Disease (ESRD) Beneficiary in the 18 month coordination period with an employer group health plan | C | Conditional payment by Medicare; future reimbursement expected | D | Automobile no-fault or any liability | E | Worker's compensation | F | Public Health Service or other federal agency (other than Department of Veterans Affairs) | G | Working disabled beneficiary (under age 65 with LGHP) | H | Black Lung | I | Department Of Veterans Affairs | J | Any liability insurance | M | Override code: EGHP services involved | N | Override code: Non-EGHP Services involved | X | MSP cost avoided override code | Y | Other secondary payer investigation shows Medicare as primary payer | Z | Medicare is primary payer |
Race The race of a beneficiary. Key | Description |
| N/A | 0 | Unknown | 1 | White | 2 | Black | 3 | Other | 4 | Asian | 5 | Hispanic | 6 | North American Native |
Railroad Retirement Board (RRB) Identifier assigned by the Railroad Retirement Board (RRB) to the Railroad employee or retired Railroad Medicare beneficiary. Repayee Indicator The repayee flag that identifies the address as a representative payee of the beneficiary for cash benefit purposes. Indicates if a person other than the beneficiary is receiving the checks. Social Security Number (SSN) A nine-digit number issued to U.S. citizens, permanent residents, and temporary (working) residents under section 205(c)(2) of the Social Security Act, codified as 42 U.S.C. § 405(c)(2). The number is issued to an individual by the Social Security Administration, an independent agency of the United States government. State The two-character state abbreviation of residence for the beneficiary. Telephone The telephone number for the beneficiary. ZIP Code The ZIP Code for the listed address. Coverage Coverage Enrollment Date The date the coverage became effective for this beneficiary. Coverage Enrollment Reason The reason for a beneficiary's enrollment to Medicare benefits. Key | Description |
| Not applicable. Example: Part A data is generated at age 64 years, 8 months | A | Attainment of age 65 | B | Equitable relief | D | Disability (under age 65 entitlement) | G | General Enrollment Period (GEP) | H | Entitled based on health hazard | I | Initial Enrollment Period (IEP) |
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