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  1. QRDA Issue Tracker
  2. QRDA-326

Identification of Medicare HIC numbers required for reporting

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      We have received confirmation from the Division of Medicare Enrollment Coordination that all Medicare beneficiaries are assigned a HIC number. Therefore, for the 2016 reporting period, the PQRS system will continue to perform the same validation performed for the 2015 reporting period, which is:
      The PQRS system will reject QRDA-I files where any payer includes any Medicare SOP code (all SOP codes listed below), but they don’t provide a HIC number:
       1 MEDICARE
       11 Medicare (Managed Care)
           111 Medicare HMO
           112 Medicare PPO
           113 Medicare POS
           119 Medicare Managed Care Other
       12 Medicare (Non-managed Care)
           121 Medicare FFS
           122 Medicare Drug Benefit
           123 Medicare Medical Savings Account (MSA)
           129 Medicare Non-managed Care Other
       19 Medicare Other
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      We have received confirmation from the Division of Medicare Enrollment Coordination that all Medicare beneficiaries are assigned a HIC number. Therefore, for the 2016 reporting period, the PQRS system will continue to perform the same validation performed for the 2015 reporting period, which is: The PQRS system will reject QRDA-I files where any payer includes any Medicare SOP code (all SOP codes listed below), but they don’t provide a HIC number:  1 MEDICARE  11 Medicare (Managed Care)      111 Medicare HMO      112 Medicare PPO      113 Medicare POS      119 Medicare Managed Care Other  12 Medicare (Non-managed Care)      121 Medicare FFS      122 Medicare Drug Benefit      123 Medicare Medical Savings Account (MSA)      129 Medicare Non-managed Care Other  19 Medicare Other

      Comments were added to QRDA-250 after it was closed. Please reopen this ticket as it has context which would require extensive copy-paste to move to this ticket as well as keep the thread under one ticket

            yanheras Yan Heras
            mhinterberg@ofmq.com Michelle Hinterberg (Inactive)
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