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HI 00901: Hospital Insurance Entitlement

Effective Dates: 03/04/1991 - Present

TN 2 (02-91)

The following procedures apply only when the beneficiary had received a HI card. If the beneficiary never received a card, these procedures delay resolution of potential problems.

NOTE: If there is any doubt, follow nonreceipt procedures in HI 00901.225. For RRB involvement,follow procedures in HI 00901.165.

This table describes the action necessary for FO replacement of lost HI cards:

Step Action

1

Examine the microfiche in accordance with HI 00901.020.

  • If the name and claim number are ascertained, go to Step 4.

  • If the name and claim number cannot be ascertained, go to Step 2.

2

Obtain the name and claim number from any of the following sources:

  • SSA-250, or other FO record,

  • Award Certificate,

  • Utilization notice or Explanation of Medicare Benefits notice, or,

  • Any other official communication containing the name and claim number.

3

If a potential claim number is known,transmit an Entitlement Status Query (ESQ) (See SM 00706.005.)

  • If the name and claim number are ascertained, go to Step 4.

  • If the name and claim number cannot be ascertained, see SM 00706.130.

4

Transmit a HIC query (See SM 00706.025.). The beneficiary should receive a card within three weeks.

  • If a system response is received, follow SM 00706.040.

  • If no system response is received and the beneficiary does not receive card within 3 weeks, send a HI/MBR Status Query (HMQ) (see SM 00706.005) and when the HMQ replies are received, follow HI 00930.001.
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HI 009: Evidence of Entitlement
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HI 00920: Part A and Part B Reject (and Qualified Approval) Codes (Except Code 52)
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