The Centers for Medicare & Medicaid Services (CMS) bills the claimant for ESRD Part B (R-SMI) premiums, even if he or she is receiving a monthly RRB benefit but is not yet entitled to Medicare. The only time CMS does not bill for premiums is if the claimant is already entitled to Medicare under a Railroad Retirement Claim Number (RLCN) or if the Ledger Account File (LAF) code on the Master Beneficiary Record (MBR) is “E”. For processing instructions, see DI 11052.010E. in this section.

If the claimant meets the requirements for entitlement to ESRD, we must determine whether he or she is currently entitled to Medicare under a RLCN. A claimant will have Medicare under an RLCN only if he or she:

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  is age 65 or over, or

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  has received a disability benefit from RRB for 24 months.

A Medicare record is established if an RRB claimant is age 64 and 8 months or in the 20^th month of disability.

Secure an MBR and HI/SMI Query Response (HIQR) printouts on the claimant’s own SSN or any other SSN’s involved, such as those indicated in the answer to item 9(c) of the CMS-43 (Application for Health Insurance under Medicare for Individual with Chronic Renal Disease). Review the printouts to determine whether the:

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  MBR establishes Medicare entitlement under RRB;

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  HIQR on the RLCN shows Medicare entitlement for the claimant; or

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  XCN field of the HIQR on the claimant’s SSN shows a cross reference to an RLCN (six or nine digit number preceded by one, two, or three alpha characters, e.g., WA 123456; A 123456789).

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  MANCLR segment to your field office (FO) code to close and lock segment

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  Prepare an SSA-3601 (Non-CAPS Routing) – Enter in remarks: “Route to Benefit Technical Examiner (BTE) for Processing. Send an SSA-3103 (SSA Certification of Title II Monthly Benefits to RRB for Payment or Adjustment) to RRB”

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  Enter HI eff.         and SMI eff.         (only if ESRD dates are more advantageous than dates on MBR)

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  Indicate appropriate notice (For notice paragraph, see DI 45001.102)

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  Do not prepare an A101 (Beneficiary is already on MBR.)

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  MANCLR segment to your FO code to close and lock segment

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  Prepare SSA-3601 (Non-CAPS Routing) – Enter in remarks: “Route to Benefit Authorizer (BA) for Processing. Send an SSA-3103 (SSA Certification of Title II Monthly Benefits to RRB for Payment or Adjustment) to RRB”

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  Enter HI eff.         and SMI eff.         (only if ESRD dates are more advantageous than dates on MBR)

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  Indicate appropriate notice (For notice paragraph, see DI 45001.347)

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  Prepare an A101 on beneficiary’s own SSN with a BIC of “T”. Indicate RRB has jurisdiction.

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  Indicate appropriate notices on the report of contact (RPOC) screen and in remarks – “See RPOC for notices.”

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  On A101 route sheet-- Enter in remarks: “Route to Benefit Authorizer (BA) for Processing. Send an SSA-3103 (SSA Certification of Title II Monthly Benefits to RRB for Payment or Adjustment) to RRB”

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  Route the SSA-3601 to PC7.

In all cases in which RRB established a Medicare record under an RLCN, the BA in PC7 completes Form 3103 and forwards it to RRB.