NOTE: EXRs and initial claims with different claim types can be loaded as an MPC in EDCS. For example, an EXR Childhood Disability Benefit (CDB) claim and an initial disability (DIB) claim, can be loaded into EDCS as an MPC.

NOTE: Although Medicare is withdrawn on either the EXR or initial claim, Medicare or Medicaid will be available on the other action when it is processed. When an individual previously had Medicare and entitlement ended within 5 years, the individual does not serve another qualifying period for Medicare.

 

If the individual chooses EXR:

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  Process a withdrawal of the initial claim per GN 00206.011, GN 00206.014 and SI 00601.050.

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  Process the EXR allowance per DI 13050.060 for title II and DI 13050.061 for Title XVI.

  Take these additional steps for Title II:

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  If current entitlement exists on the initial claim, do not stop current initial claim benefits. This will avoid interruption of benefits and Medicare coverage. OCO/PC will take necessary termination, recovery and entitlement actions when it processes the EXR award.

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  Alert OCO/PC to the withdrawal via a remark on the EFBCRN screen of the EF-101 to remind it of action needed in relation to the initial claim withdrawal, if appropriate.

If the individual chooses an initial claim:

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  Process a withdrawal of the EXR request per, GN 00206.011, GN 00206.014 and SI 00601.050.

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  Add a statement to the withdrawal request that the individual understands that the withdrawal will end provisional benefits (and provisional Medicare/Medicaid if applicable), and that the individual understands that they will have Medicare/Medicaid on the initial claim and a new Initial Enrollment Period (IEP) will also apply.

a. Title II initial claim award

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  Do not stop provisional benefits, if still being paid. This will avoid interruption of benefits and Medicare coverage. OCO/PC will take necessary termination, recovery and entitlement actions when it processes the award.

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  Adjudicate the initial claim.

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  Annotate a remark on the EFBCRN screen of the EF-101, stating “EXR filed mm/dd/yy withdrawn mm/dd/yy”, if appropriate. Also annotate remarks about the need to offset appropriate provisional or reinstated payments made against initial claim benefits due.

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  Forward the claim to the PC of jurisdiction.

b. Title XVI initial claim awards

If necessary, terminate provisional payments in accordance with SM 01701.080. Process the initial claim provisional payments and reinstated payments that have been made.