ELG.003.050

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MEDICARE-HIC-NUM

Data Element

DE Number

ELG050

System DE Number

ELG.003.050

File Name

File Segment Number

File Segment Name

VARIABLE-DEMOGRAPHICS-ELIGIBILITY

Last updated

No Updates

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	126
FLF Stop Position	137
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 = "00", then value must not be populated. 5. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [ "01", "02", "03", "04", "05", "06", "08", "09", or "10" ], then value for either HICN or MBI is mandatory and must be provided

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

RULE ID	RULE Definition
RULE-2063	If the medicare hic number is populated on a non-denied claim from an IP file, then the medicare hic number reported must not contain any pipe or asterisk characters.
RULE-6765	If a segment is a variable demographics eligibility segment from an ELG file, the Medicare HIC number value reported must be compatible with the specified T-MSIS picture format: X(12).
RULE-7641	If a segment is an eligibility determinants segment from an ELG file, and the dual eligible code is '01', '02', '03', '04', '05', '06', '08', '09', or '10', and the eligibility determinants end date is greater than or equal to the TMSIS cutover date, and the primary eligibility group indicator is '1', then the MBI or the Medicare Hic number are populated and the effective and end dates on the eligibility determinants segment fall within the effective and end dates of one or more continuous variable demographic segments.
RULE-7677	If a segment is a variable demographic eligibility segment from an ELG file, and the medicare beneficiary identifier or the medicare hic num are populated, and the variable demographic element end date is greater than or equal to the TMSIS cutover date, and the primary eligibility group indicator is '1', then the dual eligible code are equal to one of the following values '01', '02', '03', '04', '05', '06', '08', '09', or '10' and the effective and end dates on the variable demographic eligibility segment fall within the effective and end dates of one or more continuous eligibility determinants segments.

Measure ID	Measure Name
RULE-7559	% of record segments with Dual Eligible Code indicating dual status where Medicare Beneficiary Identifier and Medicare HIC Number are missing
RULE-7641	% of record segments with a valid Dual Eligible Code that have a missing value for Medicare HIC Number and Medicare Beneficiary Identifier for the same period of time

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
COT122	COT.002.122	MEDICARE-HIC-NUM	COT00002	CLAIM-HEADER-RECORD-OT
CRX079	CRX.002.079	MEDICARE-HIC-NUM	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After