For Medicare-only claims when insured status (I/S) is a factor of entitlement (e.g.,
a BIC “T” or aged claimant - not a BIC “M), and the claimant does not meet the residency requirement, input the disallowance code
for residency (i.e., 103) in the MCS Benefit Continuity Factors (BECF) screen. Additionally,
use the special message (SP MSG) field in MONET to indicate the disallowance reason,
see MSOM T2PE 007.001.
Although the BECF screen in MCS allows up to three disallowance codes to be input,
the system does not transmit derived codes to this screen. Therefore, if the claimant
subsequently attains I/S and re-files a new claim, the MBR SP MSG annotation will
provide a lead about the residency issue at a quick glance during initial contact
with the claimant. Otherwise, an incorrect Medicare allowance could result and an
unnecessary re-contact with the claimant may be required.
For a list of denial codes and their priority, see SM 00380.090.
CAUTION: Since the MCS action should process immediately, input the SP MSG action at the same
time. However, if the disallowance action is delayed and the MONET action is processed
before the MBR is established, an MBR no in file “NIF” exception will be generated
to the FO. This exception will not reflect the input language.