Complete (C)
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Notice is complete and requires no further action.
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Systems Bad (S)
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001
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T2R cannot complete a notice in a fully automated fashion and manual intervention
is required. Asterisks appear for fill-in values that cannot be determined or T2R
did not generate an introductory UTI.
Instructions:
The technician needs to
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complete the fill-in values, and
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include an appropriate introductory paragraph.
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Review (R)
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Notice is complete but needs additional information.
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002
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The Post-MBR shows a change in payee, the Person Information database or Pre-MBR does
not contain a valid address for the beneficiary, and the Representative Payee Data
(REPD) line shows:
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Type of Payee (TOP) is not equal to A (Self-SEL),
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Custody Code (CC) is not equal to V (in payee’s custody),
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Competency Code (CMC) = Y, and
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The beneficiary is age 18 or older.
Instructions:
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The technician reviews and sends the notice to the beneficiary to inform him or her
of the new payee.
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The technician can obtain the beneficiary’s address from the Representative Payee
System (RPS) or Supplemental Security Income Record (SSR).
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020
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There is a new hospital insurance (HI) occurrence with HI-TYPE = P (PREMIUM), a new
Supplementary Medical Insurance (SMI) occurrence and no Hospital Insurance Premium
(HIPR), or Supplementary Medical Insurance Premium (SMPR).
Instructions:
The technician reviews the action as well as the notice. If HI/SMI is open, there
should be an HIPR or SMPR occurrence on the Post-MBR.
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Incomplete (I)
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The notice needs additional language added. The code is generated if the following
conditions are met:
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003
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A HI/SMI occurrence based on Disability Insurance Benefits (DIB) is established. The
T2R enrollment process establishes the DIB HI (free) and SMI granting equitable relief
based on the time limitation for CMS payment of Part B (SMI) bills for medical claim
services.
Instructions:
The technician needs to add the AURORA (manual notice system) paragraph “Supplementary
Medical Insurance based on Disability” (SMID) to the notice.
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004
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A beneficiary requests waiver of equitable relief for SMI (meaning the beneficiary
wants the earlier SMI coverage).
Instructions:
The technician needs to add the AURORA (manual notice system) paragraph “Supplementary
Medical Insurance based on Disability” (SMID) to the notice.
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007
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This is used for three scenarios:
The Post-MBR History Reason for Suspension or Termination (HRFST) = OTHTRM.
The HRFST = CHDTRM and there is a changed Child in Care (CIC) occurrence with the
CIC-ENDRSN = Other Child Termination Reason (O).
The HRFST = Disability Insurance Benefits Cessation (DIBCES) and there is a changed
CIC occurrence with the CIC-ENDRSN = Other Child Termination Reason (O).
Instructions:
The technician needs to determine the specific termination reason and add dictated
language to the notice.
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008
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The Post-MBR History Reason for Suspension or Termination (HRFST) = CHDTRM and there
is a change in more than one occurrence of Child in Care (CIC) Data. All the occurrences
of changed CIC Data show the same CIC-END date with the CIC-ENDRSN = Death (D) and
there is more than one deceased beneficiary.
Instructions:
The technician needs to add a paragraph using the names of all deceased beneficiaries
(PIC C’s). This paragraph explains to the BIC B or BIC E that SSA terminated benefits
because named C’s were the last children in their care.
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009
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The Post-MBR History Reason for Suspension or Termination (HRFST) = Miscellaneous
(MISCEL) for any effective date that the pre-MBR does not show with the HRFST = MISCEL.
Instructions:
The technician needs to review the case to determine the reason SSA suspended the
beneficiary and add dictated language to the notice.
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011
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On the Post-MBR, if a Prior Month Accrual Amount (PAMT) is present and is > $0.00,
the PAMT-PAID date equals the Run Date and no UTIs generate under Caption INFC17.
If ADJ048 or HIB111 generates, process as a complete notice.
Instructions:
The technician needs to determine why we are paying the Prior Monthly Accrual (PMA)
and add language to the notice.
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012
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A new overpayment was established and The Historical Date of Entitlement Termination
(BCLM-DOETERM) on the Post-MBR is earlier than the BCLM-DOETERM date on the Pre-MBR
for the same occurrence of Beneficiary Claim Data (BCLM). We cannot use the language
in UTI OPT122 when the termination changes to an earlier date.
Instructions:
The technician needs to review the case and include information about the termination
date changing to an earlier date.
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013
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The Payee Name and Address Legend (PNAL) data does not contain the word “FOR”, "GDN
OF" or "CONS OF". T2R uses the RPY073 to tell the beneficiary the name of the new
payee. The RPY073 UTI value for Fill-in 1 is the new payee’s name.
Instructions:
The technician needs to fill-in the new payee’s name.
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014
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The Payee Name and Address Legend (PNAL) data does not contain the word “FOR”, "GDN
OF" or "CONS OF". T2R uses PAY084 when the beneficiary has a new payee and a Current
Amount (CAMT) check is paid. The PAY084 UTI value for Fill-in 2 is the new payee’s
name.
Instructions:
The technician needs to fill in the new payee’s name.
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015
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The Payee Name and Address Legend (PNAL) data does not contain the word “FOR”, "GDN
OF" or "CONS OF". T2R uses the PAY085 UTI when a beneficiary has a new payee and a
Prior Month Accrual Amount (PAMT) and a Current Amount (CAMT) check are paid. The
PAY085 value for Fill-in 2 is the new payee’s name.
Instructions:
The technician needs to fill in the new payee’s name.
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016
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The Payee Name and Address Legend (PNAL) data does not contain the word “FOR”, "GDN
OF" or "CONS OF". T2R generates PAY126 when a beneficiary has a new payee, we paid
a Current Amount (CAMT) check, and benefits are terminating Current Operating Month
(COM) + 1. The PAY126 value for Fill-in 2 is the New Payee’s Name.
Instructions:
The technician needs to fill in the new payee’s name.
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018
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T2R terminated benefits for History Reason for Suspension or Termination (HRFST) =
CHDTRM and the CIC-END date is not equal to Historical Date of Entitlement Termination
(BCLM-DOETERM). The T2Redesign Enrollment and Eligibility process will use the HRFST
= CHDTRM. In certain situations, the BCLM-DOETERM date does not equal the CIC-END
date.
Instructions:
The technician needs to explain why the termination date does not equal the CIC-END
date.
EXAMPLE: In Current Operating Month (COM) 05/04, HA dies 04/04.
Pre-MBR shows HC1 terminated HRFST = CMARRY.
Pre-MBR shows HB2 suspended HRFST = CERTEL (B2 is age 62) with CIC-END date.
Post-MBR shows HB2 terminated 04/04 HRFST = CHDTRM with CIC-END date.
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019
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Benefits are suspended with History Reason for Suspension or Termination (HRFST) =
LEGIS2. The HRFST is used for interim processing until full automation is implemented.
Instructions:
The technician needs to review the notice to include appropriate Legislative language.
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021
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More than one beneficiary dies and the Beneficiary Dates of Death (BDOD) are not equal;
or there are more than three dead beneficiaries and their BDODs are equal. T2R suppresses
the UTI OPT133 under Caption INFC17.
Instructions:
The technician needs to fill-in the deceased beneficiaries names and dates of death
when either of these situations occur.
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022
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Reverse Jurisdiction Start is present and the Monthly Benefit Amount (MBA) is still
reduced; however, no Amount of Offset Stop Date (AMOF-STOP) is on the post-MBR.
Instructions:
The technician needs to explain why the MBA is still in offset.
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025
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There are more than 20 Medicare Advantage Reduction Data (MARD) occurrences from the
first point of change on.
Instructions:
The technician must determine the correct MARD occurrences. Add UTIs MHP013, MHP014,
MHP008 and MHP018 to the notice to explain the reduction of Part B premium due to
Medicare Advantage.
NOTE: When the T2R notice process generates a complete automated notice with MHP013, MHP014
and MHP008, if there are MARD occurrences on the pre-MBR that are now wiped out, the
T2R notice attempts to include the wiped out occurrences in MHP008. For a wipe out,
MHP008 shows the reduction amount as $0.00 and the Supplementary Medical Insurance
(SMI) amount after reduction reflects the beneficiary’s full SMI rate.
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026
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The History Reason for Suspension or Termination (HRFST) = TWPFRD for an ongoing or
embedded period of suspension.
Instructions:
The Fraudulent Unit in the Processing Centers needs to add special language to the
T2R notice.
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028
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The Master Beneficiary Record (MBR) is updated with a new open Hospital Insurance
(HI) occurrence with the HI-TYPE = P, a new open Supplementary Medical Insurance (SMI),
a new open SMI Third-Party (SMTP) occurrence, and the SMI Start date is earlier than
the SMTP Start date.
Instructions:
The technician needs to determine if the beneficiary owes SMI premiums in addition
to the HI premiums for months prior to the third-party start date.
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029
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The Income-Related Monthly Adjustment Amount (IRMAA) affects the Supplementary Medical
Insurance (SMI) premium amount and there are more than three SMI premium rates and
effective dates. UTI HIB005 currently only allows for three rates and dates.
Instructions:
The technician needs to provide all SMI rates and corresponding effective dates.
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030
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The T2R notice process determines that Income-Related Monthly Adjustment Amount (IRMAA)
affects the Supplementary Medical Insurance (SMI) premium amount but after comparing
the IRMAA amounts there is no change and Deductions and Additions History (DAH) data
shows DAH-ITEM 175 or 180 (Part B refund).
Instructions:
The technician needs to determine if the Medicare Part B refund indicated in DAH data
is due to IRMAA since there is no change in the Part B premium amount.
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031
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Premium Relief data is present on the Post-MBR and the Relief Establish date equals
the Post-Entitlement (PE) run date. The Relief Reason is not equal to Income-Related
Monthly Adjustment Amount (IRMAA) or IRMAA D.
Instructions:
The technician needs to explain the reason(s) we are offering relief for the Supplementary
Medical Insurance (SMI) premiums due.
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032
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Going from a Variable Supplementary Medical Insurance (VSMI) rate to a non-VSMI rate
and T2R does not generate the UTI HIB005. In addition, VSMI data is deleted or a VSMI-TERM
date updates to the post-MBR.
Instructions:
The technician needs to review the notice to include information about the change
in rate.
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033
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There is more than one occurrence with the History Reason for Suspension or Termination
(HRFST) = WINFAL.
Instructions:
The technician needs to explain the Start and Stop dates of each WINFAL occurrence.
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034
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There are more than four Annual Earnings Limit amounts.
Instructions:
The technician needs to provide all the Annual Earnings amounts and date changes.
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036
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More than four Annual Earnings (AORE) amounts that change to zero ($0.00) exist.
Instructions:
The technician needs to provide all the years that change to zero ($0.00).
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Appointed Representative (L)
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We issue a copy of the beneficiary’s notice to an appointed representative. This code
is generated when:
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Supplemental Security Income (SSI) Windfall is processed and,
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An appointed representative is present and,
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The Registration, Appointment and Services for Representatives (RASR) system does
not show the representative as the active principal representative who is approved
for direct payment.
NOTE: T2R produced and released a complete notice to the beneficiary. A copy of that notice
is in AURORA.
Instructions:
The technician should review the notice and process through Aurora. A cover letter
addressed to the appointed representative on the notice should be the only change
to the notice.
If the beneficiary has more than one representative, the technician sends only one
copy to the principal representative per GN 03910.040C.1.Note.
NOTE: Due to the Print Mail Cost-Savings project, implemented in May 2013, do not generate
ENC003 (enclosures) on the attorney copies of notices.
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Manual (M)
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You must prepare a manual notice because the T2R notice program cannot explain the
processing situation. In most situations, you need to use dictated language to explain
the T2R action. We list the conditions that require preparation of a manual notice
below.
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101
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Limited group payer
When a group payer pays for a limited period of Medicare, prepare a manual notice.
The notice needs to explain the group payer buy-in and buy-out period and the effect
this period has on the beneficiary’s HI/SMI coverage.
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102
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Third-party wipe out processed
When a third-party wipe out action is processed, the technician needs to prepare a
manual notice. Prepare a notice to explain that the third-party data is being deleted
because it was erroneously established (refer to wipeout processing in SM 03040.245B.3).
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103
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Medicare application withdrawal processed
When the pre-MBR has an open HI/SMI occurrence and the post-MBR is updated with an
HI-NONCOVRSN = X and the HI-BASIS is not End-Stage Renal-Disease (E); or an SMI-NONCOVRSN
= X and the SMI-BASIS is not E. Prepare a manual notice when the HI/SMI BASIS is not
E. The notice needs to explain that a withdrawal of a Medicare application was processed.
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104
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Monthly Benefit Amount is less than the Supplementary Medical Insurance premium amount
(LESSDO) and the beneficiary is in LAF S9 with past premiums due
When the beneficiary goes from current pay status (LAF C) to suspended (LAF S9) with
History Reason for Suspension or Termination (HRFST) of LESSDO (Monthly Benefit Amount
is less than the Supplementary Medical Insurance premium amount), and owes past SMI
premiums. Prepare a manual notice to explain the S9 suspension and the amount of any
premiums due. T2R can only address the S9 suspension when it is effective with the
current operation month. For instruction on processing LESSDO cases refer to SM 00850.475.
NOTE: If BENH01 is included on the manual notice, review to determine if BEN125 should be
added to the notice.
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105
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Multiple third-party closed periods posted
If multiple third-party actions are processed and the updated MBR shows two or more
closed third-party periods either being established or changed for the same coverage
type, prepare a manual notice to explain the closed periods of coverage. In addition,
provide the beneficiary with information regarding medical expenses for the closed
periods.
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106
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Special Payment Amount Overpayment Disposition Amount (OPA) posted to Beneficiary
Over/Underpayment Data (BOUD) – Termination status to termination status
When the pre-MBR has a Special Payment Amount (SPA) overpayment and the beneficiary
is in terminated status (LAF = T (any except T1)) with post-MBR Beneficiary Over/Underpayment
Data (BOUD) where the Due Process Overpayment (DPO) is equal to the pre-MBR DPO plus
SPA and there is no change in the Historical Date of Entitlement Termination (BCLM-DOETERM)
on the pre- and post-MBR, prepare a manual notice to advise the beneficiary of the
overpayment posted to BOUD. In these situations, the SPA overpayment was incorrect
and the technician should have posted the overpayment to BOUD. The T2R Summary Business
Function recognizes this and is now posting the overpayment to BOUD. The T2R notice
process has to assume that we never advised the beneficiary of the SPA overpayment.
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107
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Suspension for withdrawal claim
If benefits are suspended with History Reason for Suspension or Termination (HRFST)
= WITHDR and the Beneficiary’s Date of Death (BDOD) = zeroes on the post-MBR, prepare
a manual notice to send Exhibit 3700 to the beneficiary.
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109
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Multiple fugitive felon occurrences changed
If there is more than one changed fugitive felon (FFEL) occurrence when comparing
pre-MBRs and post-MBRs, the technician needs to determine the changed occurrences
and prepare a manual notice that addresses the particular warrant date(s). The T2R
notice process only has language for one changed occurrence.
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110
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Warrant issuing agency name is blank
If the warrant-issuing agency name is blank or not available to the T2R notice process,
the technician needs to determine the agency’s name and prepare a manual notice.
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111
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Master Beneficiary Record Originating Agency Identifier (ORI) and warrant data do
not
match on Fugitive Felon SSA Control File (FFSCF)
If the Fugitive Felon (FFEL) data and the Fugitive Felon SSA Control File (FFSCF)
data do not match, the technician in the Program Service Center needs to determine
the FFSCF data that corresponds to the FFEL occurrence. Prepare a manual notice based
on the FFEL update.
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112
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Workers’ Compensation/Public Disability Benefits stop and no Amount of Offset (AMOF)
data present
If the T2R notice process has determined that we are no longer reducing or withholding
the Monthly Benefit Amount (MBA) because of WC/PDB and the post-MBR does not contain
Amount of Offset (AMOF) data (the AMOF data should be present on the MBR when WC/PDB
stops), the technician needs to review the MBR and prepare a manual notice that contains
dictated language to explain the action.
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113
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Fugitive Felon (FFEL) suspension – no change in FFEL occurrences
If The T2R system suspends benefits based on the History Reason for Suspension or
Termination (HRFST) of Fugitive Felon (FUGFEL), and the FFEL data was previously updated
to the MBR when the beneficiary was placed in suspense for PRISON then the T2R notice
process cannot determine what FFEL occurrence the suspension corresponds to because
there is no change in pre-FFEL and post-FFEL data. The technician needs to determine
the appropriate FFEL occurrence that corresponds to the fugitive felon suspension
and prepare a manual notice.
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114
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Title II Interactive Computation Facility (ICF) input – Workers’ Compensation data
deleted on post-MBR
If Injury or Illness (INIL) Data is present on the Pre-MBR and all INIL occurrences
are deleted on the Post-MBR, the technician needs to review the case to determine
why Workers’ Compensation (WC) data was deleted. Prepare a manual notice to advise
the beneficiary of the findings. If payments have not changed, do not send a manual
notice, see DI 52165.015B.6.
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115
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Multiple Annual Report Data (ARD) lines for the same Year of Earnings Report (YOER)
T2R cannot process foreign work and domestic work for the same year. Since there are
no UTIs to explain foreign work, the technician will review the case and prepare a
manual notice explaining all changes to the beneficiary.
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