The Medicare Health Insurance Claim Number (HICN) - PDF by ChrisBirchall

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									Linking Medicare, Medicare and
 Assessment data for Medicare
          Enrollees
 Frank Eppig – Some obstacles to linkage
 Dan Gilden – Validation of linkage algorithms
 Brian ODonnell – Linkage in the CCW
 Jerry Riley – Linkage to external data
Obstacles to Linking Medicare,
Medicare and Assessment data
   for Medicare Enrollees
 CMS does not control the assignment of
  personal identifiers used in the Medicare
  program, the Medicaid program, or MDS,
  OASIS, and IRF assessments
 Both Medicaid and Assessment data include
  individuals who are not covered by Medicare
     Assignment of Medicare Health
    Insurance Claim Numbers, HICN
 CMS doesn’t assign HICs to Medicare
  enrollees
 The Railroad Retirement Board (RRB) assigns
  HICs to those receiving RRB benefits
 The Social Security Administration assigns
  HICs to all others eligible for Medicare benefits
  including those who are not eligible for SSA
  benefits., such as federal employees
    The Medicare Health Insurance
        Claim Number (HICN)
   Comprised of two parts:
    1) Claim Account Number (CAN) – is the policy
       number of the wage earner who earned
       Medicare benefits
    2) Beneficiary identification Code (BIC) –
       identifier the current relationship between the
       beneficiary and the wage earner.
   When the beneficiary is not the wage earner
    the HIC is an indirect form of identification.
    The Medicare Health Insurance
        Claim Number (HICN)
   For non-RRB individuals the HICN is
    comprised of the 9 digit SSN of the primary
    account holder and a 2 position BIC that shows
    the relationship of the enrollee
   For RRB individuals the CSAN may be six or
    nine digits and is preceded by a 1, 2 or 3
    character BIC. The RRB uses fewer BICs than
    SSA and their BICs fail to distinguish between
    multiple claimants with the same relationship
    to the wage earner.
    The Medicare Health Insurance
        Claim Number (HICN)
 All HICNs have the same internal CMS
  format structure regardless of whether
  issued by SSA or the RRB
 Within CMS IT systems, the HICN is
  captured as and 11 position field with a 9
  position CAN and 2 position BIC.
    An enrollee’s HICN can change
   BIC change: When an enrollee’s relationship
    to the primary account holder changes their
    BIC changes, e.g. the shift from spouse to
    widow.
   CAN change: A Medicare enrollee may shift
    the account through which they receive
    Medicare benefits, e.g. a shift from receiving
    benefits under their own account to receiving
    benefits through a spouses' account.
    Linkage Based Upon HICS
 For CAN changes CMS maintains cross-
  reference records which map earlier HICS
  to later HICS
 For BIC changes, CMS forms groups of
  BICs. BICs within the same group are
  treated as equivalent for matching purposes.
           Medicaid Identifiers
   There are 53 Medicaid programs, each has
    their own system to enumerate Medicaid
    recipients
   Individuals who have qualified for Medicaid
    benefits in multiple jurisdictions usually have
    multiple Medicaid identifiers.
   In some cases individuals who move on and
    off Medicaid rolls within the same state will
    have multiple Medicaid identifiers.
            Medicaid Identifiers
   22.6% of those in 2007 denominator file have a
    Medicaid link key.
   This overstates 2007 Medicaid / Medicare dual
    eligibles as it includes all those that had Medicaid
    coverage at some time in their Medicare career.
   17.5% of those in 2007 denominator file have a
    buy-in indicator for 2007.
   11.5% of the 2007 Medicare population who have
    a Medicaid link key have more than one MSIS
    ID.
        Assessment Identifiers
   Each state has their own system to enumerate
    identifies for the Assessments (Resident ID)
   Individuals who receive assessment in multiple
    jurisdictions usually will have multiple
    Resident IDs.
   In some cases individuals who move on and
    off the home health or nursing home roles will
    have multiple Resident IDs.
     Assessment Identifiers
 31.4% of the 2007 denominator population
  have an assessment link key.
 This number is cumulative meaning that
  they had an assessment at some time in their
  Medicare career
 Roughly 7% of the 2007 Medicare
  population who have an Assessment link
  key have more than one Resident ID.
                Linkage logic
   For each of the three data systems (Medicare,
    Medicaid and assessments) develop an
    unduplicated person based identifier.
    – MSIS IDs to a person based Medicaid Link Key;
    – HICNs to a person based Medicare Link Key and
    – resident IDs to a person based Assessment link
      key
   Link these unduplicated identifiers across the
    three data systems.

								
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