TN 13 (11-11)

GN 01010.040 Underpayments (U/P) and Overpayments (O/P) on Prior Claims

A. Policy for reconciling prior records with O/P and U/P

The adjudicator is responsible for identifying any U/P or O/P on a prior claim and for determining whether the new claimant is eligible to receive any benefits or qualifies for O/P liability.

You must determine if there is an O/P by a prior beneficiary on the current claim or on any related social security number (SSN) by examining the following queries:

  • The Query Response Overpayment (QROP);

  • The Special Message (SP MSG) queries inquiry response (I/R);

  • The Master Beneficiary Record (MBR);

  • The Recovery of Overpayment, Accounting and Reporting (ROAR); and

  • The Supplemental Security Income query four (SSI4) overpayment unresolved (OPU) field of Miscellaneous Payment Data (MPMT) line if a prior title XVI claim is present

Note: There are separate queries for title II and title XVI claims. See MSOM QUERIES 006.024 for title II overpayments and MSOM QUERIES 006.025 for title XVI overpayments.

B. Procedure for identifying prior O/P and U/P

  • Request a Payment Worksheet (PWST) query (see MSOM QUERIES 006.017) from the Number Holder’s (NH's) termination effective date or earlier if you need to determine the cause of the title II O/P or to determine if a U/P is due.

    Note: PWST does not display data for title XVI claims.

  • Alert the title XVI Claims Representative (CR) if you discover a title II O/P or U/P that affects the title XVI claim as well. Do not initiate any title II recovery action if you are not familiar with title XVI processing. For cross program recovery (CPR) from monthly Title II benefits see SI 02220.020.

  • If a prior title II O/P exists, determine liability of repayment, following the instructions in GN 02205.003.

C. Processing claims with a prior U/P

  1. If a title II U/P exists and you determine payment eligibility but the MCS system cannot process the action, use the automated 101 (A101) or Electronic Form (EF101) process to adjudicate the claim.

  2. Annotate the Benefit Continuity Remarks/Notice (BCRN) screen with the remark “PRIOR U/P - INITIATE PAYMENT TO BIC __” to alert the processing center (PC).

  3. If after all efforts, the adjudicator cannot resolve the eligibility to a prior title II U/P, process the subsequent award (via Modernized Claims System (MCS) Earnings Computation (EC) if possible) and refer the U/P development to the PC for a post-adjudicative action, see GN 02301.070B.

D. Processing claims with a prior O/P

When processing a new claim involving a prior O/P, you must always resolve the O/P issue during the interview and before the adjudication. Discuss the prior O/P amount and recovery options with the claimant; see GN 02210.000 for Overpayment Recovery policy.

  1. If a prior title II O/P exist and you determine payment liability, do not process the new approved claim through EC. Use the A101 or EF101 process if:

    • The O/P is on the same or a related (cross-reference) SSN and the claimant is the overpaid beneficiary or was the representative payee for the overpaid beneficiary and is liable for repayment;

    • The O/P is on the same SSN, the current claimant is not the overpaid person but was previously entitled on that SSN and is due payment on the current claim for the month following the current month or any earlier month; or

    • The overpaid beneficiary died and a Lump Sum Death Payment (LSDP) is due. See GN 02210.001 for more information about Adjustments of Overpayments.

  2. Thoroughly explain the recovery procedure to the claimant if the claimant agrees with the O/P and we can recover it within 36 months.

  3. If the claimant agrees to a monthly amount deduction from the current payment to repay the prior O/P, do the following:

    • Complete and have the claimant sign a SSA-795 (Statement of Claimant or other person); and

    • Post the BCRN screen of the A101 or EF101 with O/P information and rate of withholding.

  4. If the claimant does not agree with the O/P or the recovery exceeds 36 months, do the following:

    • Explain the options of filing an appeal (e.g. SSA 561) or a waiver request (SSA-632) form as instructed in GN 02210.030</