CMS Pub. 100-24, ch. 3, § 3.3.2

Item Field Size Position Format Description

1 Medicare Number 12 1 - 12 Alpha-numeric

MANDATORY: The Medicare

number should consist of a nine-position numeric value followed

by an alpha-numeric beneficiary

identification code (BIC).

Positions 11 and 12 may be

blank. This Medicare number is

commonly referred to as the

Health Insurance Claim Number

(HICN). If the beneficiary is

entitled under a RRB number, this

field may consist of an 11-position alpha-numeric pseudo

HICN, or a 10- or 11-position

alpha-numeric value. The HICN

or RRB claim numbers are

preferred for state buy-in

exchanges. CMS will accept the

Medicare Beneficiary Identifier

(MBI), however, CMS will return

only the Medicare number on

state buy-in response files.

Item Field Size Position Format Description

2 Surname 24 13 - 36 Alpha-numeric

MANDATORY: Enter a maximum

of 24 alpha-numeric characters.

An exact match to the surname in

CMS’ systems is required on the

first six characters.

Special instructions that apply to

all of the name fields: (1) retain

blank spaces that are part of a

compound name; (2) insert a

single blank space between the

name and suffixes, such as JR,

SR, or III; (3) names may not

include a period, although other

punctuation marks (e.g., an

apostrophe or hyphen) are

allowed; and (4) all alphabetic

characters must be capitalized or

matching criteria will fail.

3 Given Name 15 37 - 51 Alpha-numeric

MANDATORY: Enter a maximum

of 15 alpha-numeric characters.

CMS requires an exact match on

the first three characters. If this

match fails, however, and CMS

has only the first initial of the

given name in its system, CMS

will accept an exact match on the

first character alone. See special

instructions above.

4 Middle Initial 1 52 Alpha-numeric

Enter a one-position alpha-numeric character. Leave field

blank if middle initial is unknown.

5 Sex Code 1 53 Alphabetic Enter a one-position code: “M”

= male, “F” = female. Leave

field blank if unknown.

6 Date of Birth

(CCYYMMDD)

8 54 - 61 Numeric MANDATORY: Enter an eight-position numeric date (e.g., enter

November 1, 1939 as 19391101).

Item Field Size Position Format Description

7 Beneficiary’s

Social Security

Number

9 62 - 70 Alpha-numeric

Enter the beneficiary's own SSN,

if known. If unknown, leave

blank.

8 Buy-in Eligibility

Code

2 71 - 72 Alphabetic/

Blank

For Part B records only; if the

state submits a Part A BIEC, it is

recorded in EDB Part A records,

but is never used by CMS. In

position 71, leave blank or enter

any code other than “P,” “L,” or

“U.” This will help to avoid

triggering a rejection. Once Part

B enrollment is established, the

state can use the code 99

procedures to update the BIEC

once it verifies Part B buy-in is

present in CMS systems. Position

72 is reserved for future

expansion.

9 Agency Code 3 73 - 75 Alpha-numeric or

Numeric

MANDATORY: Enter the three-position alpha-numeric or

numeric code of the state which

has jurisdiction over the account,

indicating whether this is a Part

A or Part B request.

10 Transaction Code 2 76 - 77 Numeric MANDATORY: Enter the two-position numeric code which

identifies the type of record

conveyed by the transaction.

Accretion action - codes 61, 63,

and 84.

Deletion action - codes 50, 51,

and 53.

Simultaneous accretion/deletion

action (closed period) - code 75.

State change record - code 99.

11 Filler 5 78 - 82

Positions reserved for future use.

Item Field Size Position Format Description

12 Transaction

Effective Date

(CCYYMM)

6 83 - 88 Numeric MANDATORY except for

transaction code 99: Enter the

date on which the accretion or

deletion action is effective (e.g.,

enter April 2019 as 201904).

13 Code 75 Stop Date

(CCYYMM)

6 89 - 94 Numeric This field is used only in

conjunction with the insertion of

a closed period of buy-in

coverage. Enter the date on

which the closed period of buy-in

coverage ends (e.g., enter June

1998 as 199806). Important: This

field is to be used exclusively with

transaction code 75.

14 Filler 6 95 - 100

Positions reserved for future use.

15 Agency Client

Identification

Number

20 101 -

120

Alpha-numeric

Enter the beneficiary's state client

(or Medicaid) identification

number or any other identifier of

the state's choice. Any

combination of not more than 20

alpha-numeric characters may be

used. Packed fields cannot be

accepted.