Normally, the State of Wisconsin will obtain State cash supplement and Medicaid eligibility
information from the SDX daily updates. They update their system once each week, at
the start of business on Thursday, with data from SSA that was updated as of the previous
Tuesday.
NOTE: Unless there is a systems problem or an urgent immediate need, HP Enterprises should
not be asked to manually issue a State cash supplement or Medicaid card on an initial
claim or reinstatement.
Use these fax numbers: State SSI cash supplement at (608) 221-0991 and manual issuance
of the Medicaid card at (608) 221-8815 with the SSI2 method only when the conditions listed above are present. If both State SSI Cash and Medicaid
are requested, send just one fax but circle both. Use the enclosed Fax Cover Sheet
to send the SSI2 or a simulated SSID. Give the SSI recipient or caller the HP Enterprises
Recipient Services Hotline number (800) 362-3002 for any follow-ups or future calls
or questions. This staff can answer both Medicaid Card and State cash supplement questions.
[Street Address] Social Security Administration
[City, ST Zip Code]
[phone]
[fax]
www.socialsecurity.gov
FAX
To: HP Enterprises State SSI Cash Unit From:
_________________________________________________________________________
Fax: Cash–608-221-0991 MA-608–221–8815 Pages:
__________________________________________________________________________
Phone: Date:
_________________________________________________________________________
Re: Circle one or both: 1-Cash 2-MA Card cc:
_________________________________________________________________________
Per SSA Instructions in SI CHI01730.010
The attached printout of the Federal SSI record shows the SSI eligibility for a Wisconsin
SSI recipient. There is an immediate need or a systems limitation that prevents this
SSI recipient’s record from being read by the SDX accurately or timely. If there are
any questions on this message please contact the person identified above who has sent
this fax. Circle all that apply:
Circle all that apply:
-
-
•
SDX Systems Limitation
-
-
-
–
SSI eligibility more than 2 years in the past
-
–
New SSI eligibility exists beyond most recent nonpayment month
-
–
SSI record has One Time Payments - (see Attachment 1 — Pay Flag One) that is not transmitted over the SDX.
-
•
SSI applicant died after a signed application was received and before adjudication
and no cash underpayment is payable but there are unpaid medical expenses to be covered
by MA and a medical allowance determination have been made. SI CHI01730.015
Enclosure – SSI Printout (SSI2 data elements: PRSN, REPY, CMPH, PMTH, DRDP, ADDR)
Attachment 1 - Pay Flag One
Type of check paid or returned check indicator
Code
|
Definition
|
0
|
No payment made
|
1
|
Recurring payment dated the first of the month
|
2
|
Regular daily payment (underpayment)
|
3
|
Supplemental payment dated the first of the month
|
4
|
One time payment
|
5
|
Advance payment or overpayment recovered (amount recovered shown in check amount column)
|