CMS Pub. 100-04, ch. 27, § 40.2

SSA maintains the Master Beneficiary Record (MBR) from which the Health Insurance

(HI) Master Record is established. The CWF's eligibility record is accreted from this HI

Master Record. The HI Master Record is updated periodically from a variety of sources,

including the MBR, and in turn updates the Host maintaining the CWF record. However,

errors occur where the MBR fails to correctly update the HI Master Record or where the

HI Master Record fails to correctly update the CWF record.

If the problem is caused by difficulties in determining the beneficiary's correct

entitlement status, the A/B MAC or DME MAC must request assistance of the SSO. The

SSO is responsible for processing the case. Examples of situations covered by this

procedure are:

• Problems involving Railroad Retirement Board (RRB) jurisdiction, i.e., the RRB

has jurisdiction of the beneficiary's Medicare, and the claim was erroneously

referred to the area A/B MAC (B);

• Evidence that a beneficiary has utilization under more than one health insurance

claim number (HICN), but the MAC is not aware of any cross-reference action

taken by CMS; or

• Assistance is needed to obtain or verify a beneficiary's name and/or MBI. (See

specific procedures in §20.3.3.6 under disposition code 55.)

In the event the SSO is unable to resolve the entitlement problem, e.g., a disposition code

55 is received after SSA verified the beneficiary's name and/or MBI, the MAC requests

assistance from the RO. It includes complete details of the nature of the problem and a

description of its efforts to resolve it.