TN 3 (09-17)

GN 01050.075 Claims routing guide

This section provides information about determining Processing Center (PC) jurisdiction and routing of claims, including internet claims (iClaims). We organized the routing information in chart format by claim type (Non-Disability, Disability, and iClaims.) Claims situations not covered by these instructions include cases involving:

  • more than two PCs, or

  • dual and triple entitlement.

Employees should use their best judgment to route claims not covered by these instructions, and document the decision on a report of contact (RC). If the PC receives a misrouted claim, the receiving PC adjudicates it and processes it completely.

Route a cross-referred Beneficiary Identification Code (BIC) “T” or “M” claim on Social Security Numbers (SSN) serviced by different PCs to its own PC, accompanied by an RC regarding the other claim.

A. PC Name/SSN Area Number Range/PC Claims Jurisdiction

Use this chart as a guide to determine PC jurisdiction of a claim. In most instances, determine PC jurisdiction by SSN area number (the first three digits of an SSN.) However, in some instances, determine PC jurisdiction by the type of claim as indicated in the column labelled ‘PC Claims Jurisdiction.’
In these cases, the claim type supersedes the SSN area number when determining PC jurisdiction:

PC Name

SSN Area Number Range

PC Claims Jurisdiction

PC1
Northeastern Program Service Center (NEPSC)

000-134, 729, 805-808

Environmental Health Hazards (EHH) Medicare claims

PC2
Mid-Atlantic Program Service Center (MATPSC

135-222, 232-236,
577-584, 596-599,
691-699, 809-826

 

PC3
Southeastern Program Service Center (SEPSC)

223-231, 237-267,
400-428, 587-595,
654-658, 667-675,
681-690, 730,
752-763, 766-804

 

PC4
Great Lakes Program Service Center (GLPSC)

268-302, 316-399,
700-728, 731

 

PC5
Western Program Service Center (WNPSC)

501-504, 516-524,
526-576, 586,
600-626, 646-647,
650-653, 680,
733-751, 764-765,
827-867

 

PC6
Mid-America Program Service Center (MAMPSC)

303-315, 429-500,
505-515, 525, 585,
627-645, 648-649,
659-665, 676-679,
732, 868-899

 

PC7
Office of Disability Operations (ODO)

N/A

DIB claims (age less than 54), and End Stage Renal Disease (ESRD) Medicare claims.

PC8
Office of Earnings and International Operations (OEIO)

N/A

Foreign Claims

B. Non-disability claims routing

Use this chart as a guide to determine where to route all non-disability claims:

Situations

Routing

Remarks

1. INITIAL CLAIMS

(No Prior Claim Filed)

PC with jurisdiction of the SSN area number.

EXCEPTIONS:

Foreign involvement (see GN 01050.075B.3. in this chart);

Cross-Reference multiple folder involvement (see GN 01050.075B.5. in this chart); and

Disability involvement (see GN 01050.075C in this section).

2. SUBSEQUENT CLAIMS

PC with jurisdiction of the SSN area number.

EXCEPTIONS: Disability involvement (see GN 01050.075C. in this section);

Foreign involvement (see GN 01050.075B.3. in this chart);

Survivor involvement see GN 01050.075B.8.a. and GN 01050.075B.8.b. in this chart.

3. FOREIGN INVOLVEMENT

OEIO

Applicable:

if any claimant resides outside of the *U.S.; or

if any claimant uses a mailing address outside the *U.S.; or

if any claimant has been, or will be, outside the *U.S. for more than 6 months.

*“U.S.” includes all 50 States, the District of Columbia, American Samoa, Guam, Puerto Rico, the Northern Mariana Islands (NMI), and the U.S. Virgin Islands.

4. TOTALIZATION CLAIMS

 

See Routing of Claims for U.S. Benefits Involving Totalization in GN 01702.310; and

Routing of Claims for U.S. Totalization Disability Benefits in GN 01702.410.

5. MULTIPLE FOLDERS (Multiple Claims)

X-Reference with STAT code “R”, “P”, or BIC

 

If there is disability involvement, see GN 01050.075C in this section.

    a. Initial Claims on each SSN  

Route each claim to the PC with jurisdiction of the SSN area number (with the exception of disability and foreign.)

 

    b. Initial Claim for one NH; subsequent claim under another NH’s SSN

Route each claim to the PC with jurisdiction of the SSN area number (with the exception of disability and foreign.)

 

    c. Retirement Insurance Benefits (RIB) entitlement only

PC with jurisdiction of the SSN area number, or of each SSN area number (when there is more than one).

 

6. All other claim types not mentioned in other sections

PC with jurisdiction of the SSN area number.

EXCEPTIONS:

Foreign involvement (see GN 01050.075B.3. in this chart);

Cross-Reference multiple folder involvement (see GN 01050.075B.5. in this chart); and

Disability involvement (see GN 01050.075C in this section).

7. Lump-sum only claims

PC with jurisdiction of the SSN area number.

 

8. Subsequent claims; except

PC with jurisdiction of the SSN area number.

 

    a. Survivor claim filed when disabled primary claimant (HA) dies

PC other than ODO with jurisdiction of the decedent’s SSN area number.

 

    b. Sole survivor claim filed by RIB beneficiary

PC with jurisdiction of decedent’s SSN area number.

 

C. Disability claims routing

Use this chart as a guide to determine where to route all disability claims. Route claims with disability involvement to the Disability Determination Services (DDS), ODO, or if “foreign,” OEIO, per instructions in the chart. For age 54 Disability Insurance Benefits (DIB) claims, refer to DI 11010.280.

Situations

Pre-Adjudicative Routing

Adjudication

Post-Adjudicative Routing

DDS Jurisdiction for Disability Determination

to DDS per DI 11010.255

  

Allowance

to resident field office (FO) per
DI 32005.001 through
DI 32005.055.

FO (except adverse claim or appeal pending at ODO.

to ODO

Denial

to resident FO per DI 32005.001 through
DI 32005.055.

FO

Retain in FO per DI 11010.370.

SSA Jurisdiction for Disability Determination

to ODO per
DI 11010.255.

ODO

 

Technical Denials

 

FO

Retain in FO per DI 11010.370.

Other Claims; No Disability Determination

 

FO (except adverse claim or appeal pending in ODO)

to ODO per

DI 11010.340.

Foreign Address

to OEIO

OEIO

to OEIO.

Career Railroad

to GLPSC

GLPSC

to GLPSC.

DIB-RSI claim

See DI 11010.300

  

DIB auxiliary claim

  

PC which has the Wage Earner’s (WE’s) disability file (ODO, PC, or OEIO).

NOTE: If technical entitlement is established on one SSN, but payment will be made on another SSN, see GN 01050.060E.

D. Internet claims (iClaims) routing

Use this chart as a guide to determine where to route all iClaims: