If the denial is for medical improvement, (item 11 of the SSA-833 indicates a MIRS
denial):
-
•
Input a medical cessation through POS to stop provisional payments. For termination
instructions, see MS T2PE 003.024 and DI 13050.025J,
-
•
Use option 10=CESSATION to clear the EXR event from the Disability Control File (DCF),
If the denial is coded “not the same as or related impairment” (item 11 of 833
indicates code of 28),
-
•
Do not use POS, as the POS input terminates any Medicare coverage in effect; instead,
send a request to the program service centers (PSC) to stop the provisional payments.
When DDS denies EXR because the current impairment is not “the same as or related”
to the original disabling impairment, we do not terminate Medicare coverage,
To contact the PSC of jurisdiction:
For PSC 1-6 cases, follow locally established procedures for resolution of high priority
cases, or send a 2560HP. Enter the remark “Do not place in backlog”, and
For PSC 7 cases, send an email to ||OCO ODO PITAG.
-
•
Use option 5, SSR/MBR/STOP CDR to clear the EXR event from the DCF, per DI 13010.620.