Experience has shown that in most underpayment claims the proper recipient is readily
apparent, and that as a result of DO development, a claim will be filed by the qualified
person. Therefore, the carriers have been instructed that, if the DO has assisted
in the development of the case, they may assume that the claimant meets the requirements
to receive the underpayment. Accordingly, the DO should not forward to the carrier
a claim involving an underpayment without the evidence or statements necessary for
payment.
Upon receipt of an inquiry in the DO, ascertain whether the services in question have
been paid for. If they have not, see GN 02335.020. Where the bill has been paid, inform the individual of the requirements under which
payment can be made and offer assistance in filing if it appears the individual is
the proper recipient of the underpayment.
If another person is the potential payee, explain that the other person should file
the claim. Subject to the tolerance in B., below, contact the qualified party, or
if the circumstances permit, ask the inquirer to have the qualified party contact
the DO. Do not take a claim from an inquirer who is not qualified unless the inquirer
still wishes to file after having received a full explanation.
If the potential claimant resides in another service area, transfer the carrier assistance
request to the proper DO. If regional guidelines require it, notify the carrier of
the transfer.