TN 3 (02-95)

GN 01703.230 Totalization Status Codes (TSC)

A. Background

TSCs are two-digit codes which describe the status of claims for U.S. totalization benefits. These codes have also been developed to collect information from the MBR for accounting and statistical purposes. The presence of some TSC codes on the MBR prevents automatic HI entitlement and PSC jurisdiction transfers.

B. Definitions

1. A1

Totalization Awarded (A1) - NH is insured only by combining U.S. and foreign coverage.

Prevents automatic HI enrollment and PSC jurisdictional transfers.

2. A3

Totalization Awarded (A3) - NH is insured only with foreign coverage and the beneficiary is entitled to free HI as a Medicare Qualified Government Employee (MQGE) or an End Stage Renal Disease (ESRD) beneficiary.

3. E2

Totalization Awarded (E2) - NH entitled to totalization benefits, acquired insured status based only on U.S. QCs but continues entitlement to totalization benefits because they are higher.

4. D1

Totalization Denied (D1) - NH has less than 6 U.S. QCs.

5. D2

Totalization Denied (D2) - NH has at least 6 QCs but still does not meet insured status by combining U.S. and foreign coverage.

The use of this code includes uninsured cases where the foreign agency reports no coverage or certifies that all coverage was prior to 1937. This code can also be used to indicate that U.S. totalization benefits have been denied in those cases where an uninsured claimant with at least six QCs has filed a totalization application, but states that he or she had no coverage in the other country.

6. D3

Totalization Denied (D3) - NH is insured without foreign coverage and foreign coverage could not yield an earlier MOEN or DIB insured status.

7. D4

Totalization Denied (D4) - NH has at least 6 U.S. QCs, or is fully insured based on U.S. coverage, but does not meet another factor of entitlement such as age, relationship, or medically disabled.

8. P1

Totalization Pending (P1) - Uninsured - Claim cannot be adjudicated until foreign coverage certificate is received.

9. P2

Totalization Pending (P2) - Non-totalization claim has been awarded, but foreign coverage may yield DIB insured status or an earlier MOEN.

10. T1

Totalization Terminated (T1) - This code represents a change in status. Totalization benefits are not being paid because of a subsequent entitlement to a non-totalization benefit. This TSC is used in the following situations:

  • A totalization beneficiary subsequently becomes insured based on U.S. coverage only, resulting in higher benefits (TSC changes from A1 to T1).

  • Totalization results only in an earlier month of entitlement for a person already receiving regular benefits (TSC changes from P2 to T1)

  • Totalization results only in establishing a closed period of totalization disability entitlement.

    NOTE: In this situation, the system expects a HI entitlement date equal to the 24th month after the DIB entitlement date. This is erroneous since HI cannot be based on totalization DIB entitlement. TSC T1 has been designed to prevent that condition.

C. Procedure

Follow this procedure for documenting and posting the TSCs.

1. Documenting the folder

Enter TSC codes on Forms EF-101, A101, e4962, etc. to reflect the status of and/or the determination made on U.S. totalization claims.

2. Automatic posting to the MBR

(When an initial claim is processed through MCS, and the TB FAC code is entered, MCS will automatically post TSCs of D1, D3, D4, and P1 to the MBR in the “TOTAL” field.)

If the FAC of TB was not entered through MCS, do not post these TSCs to the MBR through MACADE.

3. Manual posting to the MBR

When processing awards, disallowances (including disability denials), or terminations manually (via MACADE), post TSCs of A1, A3, D2, D4, E2, and T1 along with the totalization country code to the MBR.

D. List Of Totalization Country Codes (TCCs)

The following is a list of the TCCs for countries with whom the United States has a totalization agreement.

CountryCode
ItalyITALY
GermanyGERMA
SwitzerlandSWISS
NorwayNORWA