HI 00825.001 HI/SMI Inquiries Received from Beneficiaries

All complaint correspondence pertaining to or arising from SMI premiums (i.e., billing, termination, or premium collection activity) or HI/SMI in general are directed to the Exceptions and Inquiries Examiner. The examiner will handle a variety of complaints and inquiries relative to an enrollee's HI/ SMI status and SMI premium deduction and collection.

Generally, the responsibilities involve a determination as to the proper action to be taken and, if applicable, replying to the correspondence received.

The following sections are intended to fully explain the methods to be employed in reconciling most HI/SMI inquiries received in the program service center. It is expected that the relatively small number of situations not covered by these procedures will be effectively handled based on the guidelines set out below.

Although the instructions in the following sections will enable an accurate handling of correspondence, other chapters of the POMS dealing with HI correspondence should be the tool used to effectively analyze the claims folder in each situation. In all cases, except as outlined below, a reply to an inquiry must be made.