CMS Query Procedures

Employee query files should be submitted monthly to CMS to determine which employees are MEDICARE eligible. 

In order to get a response from CMS on the MEDICARE status of an employee CMS requires the following data to be correct:

CMS will return and employee's HICN (MEDICARE Number) if the SSN matches their records along with 3 out of the 4 other data elements. CMS will not send any response indicating that there are data errors if the last name, first name, date of birth and gender are incorrect.  The name data must match the information displayed on their MEDICARE card.  No aliases or preferred names should be used in the first and last name fields.

The steps for sending a CMS Query file are:

Note: CMS/MEDICARE has a limit of one query file per RRE per Month.  Any additional query files submitted in a month will result in the second file being deleted and an e-mail warning from CMS/MEDICARE.

When the response file is ready to load:

Note: Not receiving results from CMS on an employee does not mean the employee is not MEDICARE eligible and does not relieve the RRE from determining their MEDICARE status. Attached below is an example form provided by CMS that could be included with the FROI package to help collect their MEDICARE information.  The HICN number can be updated/added in the employee's HRMS record by looking up the employee by using CTRL-H (entering SSN or last name) and using the menu selection "Edit --> Employee data".

Complete information on the CMS query file process can be found in the "MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation USER GUIDE Version 3.1" which can be found at