COT.002.122

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

MEDICARE-HIC-NUM

Data Element

DE Number

COT122

System DE Number

COT.002.122

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The Medicare HIC Number (HICN) is an identifier formerly used by SSA and CMS to identify all Medicare beneficiaries. For many beneficiaries, their SSN was a major component of their HICN. To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the Medicare Beneficiary Identifier (MBI) over the course of 2018 and 2019. HICN continue to be used by Medicare for limited administrative purposes after 2019 but starting in 2020 the MBI became the primary identifier for Medicare beneficiaries. HICN consists of two components: SSN & alpha-suffix or (for Railroad IDs) prefix and ID (not always SSN based)
Size	X(12)
FLF Start Position	793
FLF Stop Position	804
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Conditional 2. Value must be 12 characters or less 3. Value must not contain a pipe or asterisk symbols 4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated 5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1557	If the medicare hic number is populated on a non-denied claim header from an OT file, then the medicare hic number reported must not contain any pipe or asterisk characters.
RULE-1558	If a claim is a non-denied, non-void, crossover claim from an OT file, and the medicare beneficiary identifier is not populated, then the medicare hic number is populated.
RULE-6922	If a claim is a non-denied claim from an OT file, then the Medicare HIC number value reported must be compatible with specified T-MSIS picture format: X(12).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP196	CIP.002.196	MEDICARE-HIC-NUM	CIP00002	CLAIM-HEADER-RECORD-IP
CLT140	CLT.002.140	MEDICARE-HIC-NUM	CLT00002	CLAIM-HEADER-RECORD-LT
CRX079	CRX.002.079	MEDICARE-HIC-NUM	CRX00002	CLAIM-HEADER-RECORD-RX
ELG050	ELG.003.050	MEDICARE-HIC-NUM	ELG00003	VARIABLE-DEMOGRAPHICS-ELIGIBILITY

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.002.122	UPDATE	Coding requirement	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. Value must be populated when Crossover Indicator (COT.002.023) equals '1' and Medicare Beneficiary Identifier (COT.002.147) is not populated.	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated