All Part B-ID actions are completed in processing center (PC) 7. If the form CMS-10798
Application for Enrollment in Part B Immunosuppressive Drug Coverage form is misrouted,
load the form into PC7’s paperless system using the Evidence Portal (EP). For instructions
on loading to the EP, see DI 11052.046D. Before uploading CMS-10798 to the EP, write Part B-ID Enrollment across the top of
the form.
All actions for Part B-ID, and any actions on records that have active Part B-ID,
must be processed via the Manual Adjustment Credit & Award Data Entry (MACADE). PC
7 handles all Part B-ID enrollment and disenrollment actions. All other post entitlement
actions are processed in the PC of jurisdiction.
Enrollment requests can be identified in the paperless system by Type of Event Level
(TOEL) HISMI PBID.
Requests for enrollment may be taken over the telephone by the Office of Disability
Operations Teleservice Center, or the beneficiary may complete the CMS-10798 Application
for Enrollment in Part B Immunosuppressive Drug Coverage. If the form CMS-10798 is
completed or received by the field office, staff will upload the form into PC7’s paperless
system for processing.
Review to ensure the request is complete by:
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Confirming eligibility for Part B-ID is met using HI 00805.400. Ensure the individual is or was entitled to Medicare Part A based on ESRD that has
or will terminate 36 months after a successful kidney transplant;
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Ensuring the file contains the request to enroll in Part B-ID; and
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Ensuring the file contains an attestation that the individual does not have and does
not expect to enroll in certain other health insurance that includes immunosuppressive
drugs coverage. The beneficiary must agree to notify Social Security within 60 days
of obtaining other coverage.
NOTE: If the individual has Medicare or certain other health insurance as explained in
DI 11052.046B1, they are not eligible to enroll in Part B-ID.
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Once the request is reviewed, the benefit authorizer (BA) may input the action via
MACADE. See SM 00850.800.
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The following day, review the action to ensure the MBR updated.