Deported Medicare Beneficiaries

Original Effective Date: 12/12/2002
Revision Effective Date: 11/01/2013

Sections 226 and 226(A) of the Social Security Act (the Act) provide that no payments may be made for benefits under Part A of Title XVIII of the Act if there is no monthly benefit payable under Title II. Section 1836 of the Act limits Part B benefits to those who are either entitled to Part A benefits or who are age 65 and a United States (U.S.) resident, U.S. citizen or a lawfully admitted alien residing permanently in the U.S. Finally, a deported beneficiary is not allowed to enter the U.S. and cannot be lawfully present in the United States to receive Medicare-covered services.

Effective for claims processed on or after April 1, 2003 the Common Working File (CWF) will edit for claims processed for deported beneficiaries. Claims submitted for payment with dates of service on or after the effective date of the CWF record will be denied with the following messages:

  • ANSI reason code 96 – Non-covered charges
  • ANSI remark code N126 - Social Security records indicate that this beneficiary has been deported. The payer does not cover items and services furnished to individuals that have been deported.

A party to a claim denied in whole or in part under this policy may appeal the initial determination only on the basis of deportation status.

            Last Updated Wed, 10 May 2017 09:45:10 +0000