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815.5 Situations That Initiate Enrollment Process

815.5.1 Medicare Only Application

The application initiates manual or computer action to determine the applicant's 

entitlement to Part A and, when appropriate, to Part B.

815.5.2 Annuity Application

The application initiates manual or computer action to determine the applicant’s 

entitlement to an annuity and, when appropriate, to Parts A and B.

815.5.3 SS Certifications

RRB assumes Medicare jurisdiction for individuals whose SS benefits are certified to 

the RRB. The certification includes a determination of the beneficiary's entitlement to 

Part A and Part B and the effective dates of coverage. Based on this information, the 

RRB initiates manual or computer action to enroll the beneficiary.

815.10 Enrollments During The Initial Enrollment Period (IEP)

815.10.1 Automatic Enrollment - Attainments

Individuals who are entitled to a RR annuity, a SS benefit certified to the RRB, or for 

inclusion in the O/M for at least 6 months before becoming eligible for Medicare are 

enrolled for coverage automatically. Such enrollments are referred to as "attainments." 

The chart below indicates the month by which an individual must be on the rolls in order 

to be enrolled automatically.

If HI Is Effective In Beneficiary Must Be On The 

Rolls In The Previous

January June

February July

March August

April September

May October

June November

July December
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August January

September February

October March

November April

December May

These individuals will be enrolled for Part A and, if a resident of the U.S., will be 

automatically enrolled for Part B. Premium deductions are generally done timely and 

begin with the check paid on the first day of the month Medicare coverage begins. Little 

or no delay in receipt of the annuity or SS benefit should occur.

815.10.2 Accretions

Individuals who are not on the rolls as annuitants, IPIs, or SS beneficiaries at least 6 

months before their Medicare coverage can begin must file a benefit annuity or health 

insurance application at RRB or SSA. Such enrollments are referred to as accretions. 

Manual action is generally required in the processing of accretion enrollments; premium 

deductions will not be initiated until after an annuity is put in payment status. Examiners 

may deduct SMI premiums from initial SS benefit certifications. Individuals enrolled as 

accretions will be enrolled for Part A coverage, and if residents of the U.S., Part B 

coverage, unless SMI was refused on the application.

815.15 Enrollments After The Initial Enrollment Period

815.15.1 General Enrollment Period (GEP) Enrollment

Individuals who have Part A coverage only may enroll for Part B by submitting a 

statement requesting Part B coverage, a completed Form G-44 or a completed Form G44b during any GEP.

At the beginning of each year, enrollment kits consisting of a Form G-44, Form RB-20, 

Form G-860 and a return envelope addressed to P.O. Box 10794 are released to the 

following U.S. residents:

A. Beneficiaries who refused Part B coverage in the previous year,

B. Beneficiaries who withdrew from Part B coverage in the previous year, and

C. Beneficiaries whose Part B coverage terminated in the previous year for failure to 

pay premiums.
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815.15.2 Deemed GEP Enrollment

Part A entitlement will be established for a beneficiary who files a Medicare only, 

annuity, or O/M application after his/her IEP. If the application establishes Medicare 

entitlement for the first time, the beneficiary does not have to file an application electing 

Part B in the next GEP. An application is deemed filed in the next GEP and the 

beneficiary will be automatically enrolled for Part B unless the person refused Part B on 

the application.

815.20 Medicare Claim Numbers

815.20.1 General

A Medicare claim number is the prefix and number established on the Health Insurance 

Master (HIM) to identify a beneficiary. Once a prefix and claim number is used for a 

beneficiary, it cannot be used to identify another beneficiary. To avoid the situation 

where a beneficiary is enrolled with a previously used claim number (prefix + number), 

another number, called a pseudo number, must be assigned to all non-employee 

beneficiaries as the Medicare claim number. Refer to FOM-1-815.20.4 for further 

information about pseudo numbers.

The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization 

Act (MACRA) of 2015 required the removal of the Social Security Number (SSN) based 

Health Insurance Claim Number (HICN) from Medicare cards by April 2019. This new 

Medicare Beneficiary Identifier (MBI), assigned by the Centers for Medicare and 

Medicaid Services (CMS), will replace the SSN-based HICN on the new Medicare cards

and external Medicare forms and letters. The Medicare claim numbers and pseudo 

numbers mentioned above will still be used internally. 

815.20.2 Beneficiary Entitled to Annuity

An annuitant's RRB claim number (RR annuity or SS annuity certified to the RRB) will 

be used as his/her Medicare claim number as long as a Medicare record was not 

previously established on the claim number.

If a beneficiary is entitled to benefits under two RRB claim numbers, the primary 

number, employee or joint and survivor, will be used as his/her Medicare claim number.

815.20.3 Beneficiary Not Entitled to Annuity

A. Medicare Alone - A beneficiary who has filed for Medicare alone will be assigned 

a Medicare claim number as if he/she is entitled to an annuity.

B. Included in O/M - Beneficiaries included in the O/M will be assigned a pseudo 

Medicare claim number using the beneficiary's own SS number, or a 6-digit 

pseudo number for those without a SS number, and a prefix as follows:

Spouse - MA
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Child - CA

815.20.4 Pseudo Number - Entitled or Not Entitled to Annuity

The HIM only accepts a prefix and number to identify each individual. In addition, the 

HIM considers the MA prefix plus a number and the WA prefix plus the same number to 

be identical Medicare claim numbers. However, RRB records use a prefix, number and 

payee code to identify each individual; the same prefix and claim number with a 

separate payee code is used to identify each individual when there is more than one 

beneficiary in the same category.

Whenever a beneficiary is enrolled for Medicare and his/her RRB claim number (prefix + 

number) could have been previously used as a Medicare claim number for another 

individual, a pseudo claim number must be assigned for Medicare purposes. This 

means all non-employee beneficiaries must be assigned a pseudo number. 

The Medicare Unit (MU) will assign and process all pseudo numbers. The pseudo 

number will be the beneficiary's prefix plus his/her own SS number. Prior to December 

1, 1974, the beneficiary's prefix plus a six-digit number from 995001 through 999995 

was assigned as the pseudo number. If a beneficiary does not have his/her own SS 

number, a six-digit pseudo will be assigned. 

815.25 Basis for Determining Effective Dates Of Coverage

815.25.1 Application Filing Date

When an individual files an application for Medicare only, for an annuity, or for inclusion 

in the O/M and is eligible for Part A coverage in or before the month of filing, the filing 

date will be used to establish the Part A effective date. If it is during the individual's Part 

B IEP or GEP, the same filing date will also be used to establish the Part B effective 

date.

815.25.2 Application Deemed Filed

A. Annuity or O/M application filed prior to Part A enrollment period and prior to Part 

B IEP - An application for Part A and for an automatic election of Part B is 

deemed filed during the first 3 months of the Part A and B enrollment periods and 

is used to establish the earliest possible effective dates for Parts A and B.

B. Application filed during Part A enrollment period, but after Part B IEP - The 

application filing date will be used to establish the Part A effective date. If this is 

the first time Medicare coverage is established for the individual, an application 

for Part B coverage will be deemed filed during the next GEP and will be used to 

establish the Part B effective date. Otherwise, the individual must actually file an 

election for Part B coverage during a GEP.
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815.25.3 Date of Birth on First Day of the Month

An individual whose birthday is on the first day of the month attains age 65 on the last 

day of the previous month and the earliest effective date for Medicare coverage would 

be the first day of the month prior to the month of his or her birthday. If such an 

individual files an application in the month of his or her birthday, Part B coverage would 

not be effective until the first of the second month following the beneficiary's month of 

birth.

When developing an application, determine if the individual thought he or she had 

attained age 65 on the actual date of birth, or the day before. If so, and if the applicant 

wants the earliest Part B effective date, submit a statement from the applicant. MU will 

review the statement and determine the earliest effective date.

815.25.4 Discrepant Date of Birth - Applicant Older Than Originally Thought

An individual who has relied on particular evidence for his or her DOB and subsequently 

locates better evidence that establishes an earlier DOB, may fail to file an application 

during the correct IEP, which may have already passed.

A. Applicant files during IEP based on erroneous younger DOB - A statement 

should be submitted from the applicant explaining why he or she did not file in 

the IEP.

MU will review the statement and may establish a deemed IEP based on the 

erroneous younger DOB. The applicant's Part B effective date and premium rate 

will be based on the deemed IEP.

The Part A effective date will be established based on the actual application filing 

date and correct DOB.

B. Applicant files after IEP based on correct DOB - A statement should be submitted 

from the applicant explaining why he or she did not file in the IEP. MU will review 

the statement and establish the Part A effective date based on the actual 

application filing date and correct DOB. Part B will be determined as follows:

1. If the application was filed during a GEP, the applicant is enrolled for Part 

B in the GEP without a premium increase; or

2. If the application is not filed during a GEP, the applicant is advised to file 

during the next GEP or in the deemed IEP (based on the erroneous 

younger DOB), whichever will result in the earlier effective date.

815.25.5 Discrepant Date of Birth - Applicant Younger than Originally Thought

An individual who has relied on particular evidence for his or her DOB and subsequently 

locates better evidence which establishes a later DOB may be enrolled for Medicare 
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erroneously. Refer to item D of FOM-1-810.35.2, FOM-I-915.20.1, and FOM-I-915.20.3

for an explanation of how such a situation is handled.

Submit proof of the new alleged DOB to APPLE and image any documentation. Prepare 

an e-mail to Medicare Unit (MU) and Retirement and Survivor Benefits Division (RSBD)

explaining how and when the applicant discovered the new DOB evidence. On the email, advise that the new DOB could affect Medicare coverage.

Refer to FOM-I-845.5.6 for additional information about date of birth discrepancies. 

815.30 Establishing a Medicare Record

Action to establish a Medicare record for an individual involves the Railroad Retirement 

Board, the Social Security Administration and the Centers for Medicare & Medicaid 

Services (CMS).

815.30.1 Eligibility Determination

A determination of Medicare eligibility can be made mechanically or manually. At the 

RRB, the eligibility determination for most retirement applications, Medicare only 

applications, and attainments are made mechanically using retirement and research 

computer programs. These determinations are subsequently passed to the Medicare 

computer programs. Eligibility determinations for survivor applications, accretions, 

some retirement applications, some Medicare only applications, and some attainments 

are made by examiners. The examiner completes an input form and enters the 

information into the Medicare computer programs.

815.30.2 RRB Initial Computer Processing

Information about eligible aged and disabled Medicare beneficiaries is entered into the 

Medicare computer system MIRTEL - Medicare Information Recorded, Transmitted, 

Edited and Logged. MIRTEL edits the information, sets up a pending record for the 

beneficiary, and transmits the information to the Master Benefit Record (MBR) at SSA. 

The purpose of this action is to see if SSA has already established a Medicare record or 

has conflicting information. We are, in other words, getting clearance from SSA that 

there is no conflict.

815.30.3 SSA Computer Processing

The MBR is the computer system at SSA that contains information about all 

beneficiaries entitled to SS benefits. The MBR is also earmarked when we transmit 

information from MIRTEL as indicated in FOM-1-815.30.2 to show that RRB has 

jurisdiction of Medicare. If SMI premiums are being collected by SSA, SSA will stop 

deducting premiums and transfer jurisdiction to RRB. The information from MIRTEL is 

updated with any Medicare information from the MBR. The MBR then transmits a 

record to the Health Insurance Master record (HIM) and, at the same time, a reply to the 

RRB’s MIRTEL system.
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815.30.4 Health Insurance Master (HIM) Record Processing

Although the RRB establishes entitlement, enrolls, collects premiums and maintains a 

record for all QRRBs and deemed QRRBs, SSA in Baltimore maintains the HIM that 

permits and records payment of HI-SMI benefits. The information transmitted from the 

MBR is edited and a record is established on the RR portion of the HIM. If a record was 

previously established on the SS portion of the HIM, it is cross-referenced to the RR 

number.

If a problem is encountered during the editing or cross-referencing process, or in 

establishing the HIM record, a reject will be transmitted to the RRB and a HIM record 

will not be established.

815.30.5 RRB Final Processing

When MIRTEL receives the reply from SSA, it assumes a record will be established on 

the HIM. The pending record on MIRTEL is cleared and updated with any information 

from the MBR, a Medicare identification card is released and collection of SMI 

premiums is initiated.

815.35 Medicare Identification Card

Medicare cards are produced from two separate data processing programs. One of the 

programs processes replacement Medicare card requests entered using the MEDCOR 

Activity 62 (Duplicate Medicare Card Request) screen. The other program, which is 

part of the MIRTEL processing, generates (1) Medicare cards for individuals on the rolls 

who attain Medicare eligibility, (2) initial Medicare cards for new enrollments during an 

Initial Enrollment Period (IEP), and (3) revised replacement cards for individuals whose 

coverage changes, e.g. the beneficiary declines Part B coverage, Part B coverage is 

terminated due to non-payment of premiums, jurisdiction for Medicare is transferred 

from SSA to RRB, the beneficiary enrolls in Part B during a General Enrollment Period 

or Special Enrollment Period, or whose Medicare Beneficiary Identifier (MBI) changes, 

e.g. rare cases involving fraudulent activity under the original MBI.

In October 2007, we began revising the two data processing programs to allow printing 

of all Medicare cards on tear and water resistant paper affixed to the bottom, center of a 

full page (81⁄2 x 11) document. A Form RL-860 series letter is printed above the peel-off 

Medicare card. The revised forms are printed using a digital imaging system, rather 

than an impact printer. The revised format improves the print quality on the cards, 

safeguards personally identifiable information displayed on the cards, and streamlines

the mailing process. The form number for all Medicare cards issued using the revised 

programs is Form G-41, with a 12-2006 version date. 

815.35.1 Initial ID Card

A Medicare identification (ID) card is automatically released to the beneficiary after the 

reply is received from CMS. The card serves as a notice to the beneficiary of his or her 
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coverage and the identifying information established on the HIM. A Booklet RB-12, 

Welcome to Medicare, is mailed with the initial Medicare card to beneficiaries residing in 

the United States. A Medicare and You handbook is also mailed to the beneficiary 

separately by CMS.

The Medicare ID card will show the beneficiary’s name in a specific format. The card will 

be formatted to match the name format of the Medicare master records. The card will 

show the beneficiary’s first name or initial, middle initial only, and the surname. The 

system will not allow for the following:

• First initial and middle name (i.e. J. Alexander Hamilton)

• Hyphenated last names (i.e. Patricia William-Jones)

• Suffixes (i.e. Michael Luther Sr. or Len Washington III) 

Medicare ID card Form G-41 (version 04-1973) is released to beneficiaries enrolled for 

Part B under the automatic enrollment (attainment) provisions. The back of the card 

can be used by the beneficiary to decline Part B coverage. (Note: Changes to the 

program to print initial Medicare ID cards in attainment cases are targeted for 

completion in late 2008. When completed, the program changes will enable printing of 

the ID cards on the 12/2006 version of Form G-41.) 

815.35.2 Compromised MBI

The Medicare Beneficiary Identifier (MBI) is assigned by the Centers for Medicare and 

Medicaid Services (CMS). If a beneficiary feels that his/her MBI has been compromised, 

he/she will have to contact CMS at 1-800-MEDICARE to request a new MBI. 

After the new MBI is assigned, the beneficiary will receive an RL-330 informing him/her

of the new Medicare number. The beneficiary will also receive a new Medicare card with 

the new number. 

Once the new number has been assigned the beneficiary can go to MyMedicare.gov to 

print out a temporary card, if needed. 

If the compromise is believed to be at the fault of the RRB, an email should be sent to 

P&S-Medicare for handling. P&S will contact CMS.

815.35.3 Replacement Medicare ID Cards 

Field offices may generate a replacement Medicare card for release to a beneficiary 

who reports his or her card lost, stolen, misplaced or destroyed. The replacement card 

will contain the same MBI as the original card. If the beneficiary feels their MBI was 

compromised, see FOM1_815.35.2. Field offices should prepare a MEDCOR Activity 62 

to generate the replacement Medicare card. The card will be printed with Form RL-865. 

Access the MEDCOR Duplicate Medicare Card Request screen by entering 62 in the 

Activity Input field on the main MEDCOR MENU screen. Here are step-by-step 

instructions.
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Step Action

1 Select MEDCOR (27) from the RRAPID Main Menu.

2 Complete the following fields on the MEDCOR Menu screen:

Unit Enter “BFS”

Claim Number Enter the beneficiary’s RRB claim number, 

including symbol and prefix.

Ben SSA Number If the beneficiary is other than an 

employee and does not have a pseudo 

number, enter the beneficiary’s SS number. 

Otherwise, leave blank.

Pseudo Number If the beneficiary is other than an 

employee and has a pseudo number, 

enter the beneficiary’s pseudo number. 

Otherwise, leave blank.

Activity Input Enter “62”

Press Enter.

3 Review the information on the Activity 62, Duplicate Medicare Card 

Request screen, to ensure it is correct. If okay, press PF2. The 

message “To Add, Press PF2 Again” will appear. Press PF2 again to 

complete the request.

If the address on record is incorrect or the annuitant requests that the 

duplicate Medicare card be mailed to a temporary address, you can 

replace the prefilled address with the new or temporary address before 

pressing PF2 twice to complete the transaction. Keep in mind that this 

only changes the address for purposes of mailing the card. If a 

permanent address change is needed, you must complete a FAST-COA 

and/or MEDCOR Activity 22L.

Note: Do not enter 62L in the Activity Input field; enter 62. The L refers to the type of 62 

activity. All activity screens that are accessed directly from the main MEDCOR Menu 

are “long” form versions. If you enter an “11” in the Activity Input field on the main 

MEDCOR MENU screen, you access the MEDCOR Miscellaneous Input Screen. This 

screen is referred to as the “short” form version. Various activities can be created using 

the MEDCOR Miscellaneous Input Screen. If you request a 62 activity from the 
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MEDCOR Miscellaneous Input Screen, the system generates a 62S, or the “short” form 

version. The Pending Activities List screen and the Completed Activities List screen on 

MEDCOR will show either a 62L or 62S depending on which screen was added to 

generate the duplicate Medicare card. Requests for Medicare cards using the activity 

62L are generated daily. Instructions for using the MEDCOR Pending Activities List 

Screen (Screen MCMU017) can be found in RCM 3.13.19. Instructions for using the 

MEDCOR Completed Activities List screen (Screen MCMI018) can be found in 

RCM 3.13.20. 

Field offices should use the MEDCOR Duplicate Medicare Card Request screen to 

process all requests for replacement Medicare cards, except in cases involving 

emergency situations or when the beneficiary feels their MBI was compromised. In 

emergency situations, the field office may generate a replacement Medicare card using 

RRAILS Form RL-865-F. See FOM-I-1745, Form RL-865 for complete instructions on 

preparing replacement Medicare cards in emergency situations. For cases where the 

beneficiary feels their MBI was compromised, see FOM1_815.35.2. 

If a beneficiary needs their Medicare card, and cannot wait for one to be mailed to them, 

they can access their account (or set up an account) at MyMedicare.gov to print a

temporary Medicare card. 

815.35.4 Automated Internet Requests for Replacement Medicare ID Cards - 

Requests for replacement Medicare cards received from beneficiaries using the Benefit 

Online Services and from customer service representatives using the Palmetto GBA 

application are sent to MEDCOR each night via the Automated Internet Request (AIR) 

application. 

The transactions will be shown as ‘completed’ in their respective database, once the 

transaction has been processed for handling. If a transaction does not pass one or 

more edits, a referral will be generated to USTAR.

Field offices have responsibility for handling the referrals and therefore, will need to 

access USTAR each business day in order to review all requests for Medicare cards 

that rejected from the AIR processing. 

The chart below provides a list of the AIR referral codes, a description of each referral 

code, and the action needed to resolve the referral. 

Record 

Status 

Code

Referral 

Code

Referral Description Action Needed

M00 No record found under this 

SSN.

Contact beneficiary 

for correct number
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01 M01 Annuity APPL filed, 

screening reply pending.

Contact the Medicare 

Unit for status.

02 M02 No ANN APPL filed, 

screening reply pending.

Contact the Medicare 

Unit for status.

03 M03 ANN in SUSP Contact the Medicare 

Unit for status.

04 M04 ANN in SUSP Contact the Medicare 

Unit for status.

05 M05 Attainment, screening 

reply pending.

Contact the Medicare 

Unit for status.

M09 Dual Annuitant Release Medicare 

card under correct 

claim number.

90 M90 Cessation of Disability –

No longer entitled to 

Medicare

Contact the 

beneficiary.

98 M98 No longer QRRB Contact the 

beneficiary.

99 M99 BENE deceased No card should be 

released. Contact 

requestor. 

M10 Zip Code reported does 

not match Zip code on 

record. 

Contact the 

beneficiary for correct 

zip code.

M11 Transaction not allowed. A 

MEDCOR transaction is 

already pending for this 

claim number. 

Only one transaction 

allowed per day. 

Check to see what is 

pending, if different 

transaction, enter 

request next day.