Effective Dates: 04/21/2016 - Present Previous | Next

TN 13 (11-11)

GN 01010.200 Claims Processing Methods

A. Policy on processing claims

You can process a title II claim to payment, denial, disallowance, abatement or pre-effectuated withdrawal through different methods. Always use the method that will process a claim most accurately and expeditiously. If possible, process claims completely through the Modernized Claims System (MCS) rather than the Manual Adjustment Credit and Award Data Entry (MACADE) or the Manual Adjustment, Credit and Award Process (MADCAP).

These methods are included below in the order of preference:

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    MCS – Earnings Computation (EC);

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    Manual awards:

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    Automated 101 (A101);

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    Electronic Form 101 (EF101);

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    Manual denial or disallowances (i.e., MADCAP or MACADE).

B. Procedure for processing claims

MCS is the system that creates and controls most claims applications. MCS automatically evaluates the information the adjudicator enters into the screens to confirm or determine entitlement eligibility, benefit computation, payment status and monthly payment amounts for the specific type of benefit.

1. Earnings Computation

The MCS EC screen is the final claims path that lets the adjudicator process the claims through MCS. The EC screens display the earnings record, compute the benefit amount and establish the Master Beneficiary Record (MBR) after the claim adjudication. EC also certifies a request for payment to the U.S Treasury and releases notices to the claimant. For more information, refer to GN 01010.010.

2. Manual awards

Some District Office Final Authorization (DOFA) claims contain special characteristics, which prevent using MCS EC to effectuate the claim. For those claims, you must use the A101 or EF101 process. You can also process Non-DOFA claim via A101 or EF101 however, the Processing Center (PC) is responsible for the adjudication and effectuation of the claim. In either situation, the PC receives the claim then processes to completion using the MADCAP system.

a. The A101 process

The principal objective of the A101 process is to create the data input that MACADE requires to process the claim. The A101 screens contains information propagated from the MCS front-end (i.e., application), the MCS back-end process (the Earnings Computation (EC) process), and the MBR if one exists. You must review the propagated information, enter new information or correct erroneous information before transferring the claim to the PC of jurisdiction. Refer to MSOM MCS 014.001 for more information about the A101 process and exclusions.

b. The EF101 process

You must process claims that are A101 exclusions via EF101. The EF101 as the A101 process serves as a method to process initial, subsequent or amended awards. Most of the screens and fields in the EF101 are comparable to the A101 screens. For more information about the EF101 process, refer to MSOM T2PE 009.001.

3. Manual denial or disallowances

Claims that are created using MCS and contains special characteristics, which precludes using MCS EC to deny or disallow the claim, are processed using the MACADE disallowance screen, see SM 00380.500 for more information.

C. References

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    GN 01010.010 MCS – Earnings Computation (EC) screens

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    GN 01010.205 MCS – Earnings Computation (EC) processing

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    MSOM MCS 014.001 Automated SSA-101 Process

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    SM 00380.500 Overview of MACADE Disallowance Function

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    MSOM T2PE 009.001 Electronic Form EF101 Process

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201010200
GN 01010.200 - Claims Processing Methods - 04/21/2016
Batch run: 04/21/2016
Rev:04/21/2016