TN 43 (05-11)

GN 02602.200 HI System DOD Alert

A. Introduction

The “HI System DOD” alert generates when the date of death (DOD) on the Master Beneficiary Record (MBR) differs from the DOD on the Health Insurance (HI) System. These alerts require immediate resolution to ensure prompt and accurate payment of the HI Part A medical bill. Medicare does not pay these bills unless the charges are for services provided on or before the month, day, and year of death shown on the “HI” system.

B. Example of HI system DOD alert

Follow the sample format below to read HI alerts:

HI SYSTEMS           DOD ALERT        

ACCOUNT NUMBER    BIC   PCOC         RUN DATE

 

BENEFICIARY NAME   SEX   DATE OF BIRTH

(6 letters of surname and initial)

 

HI DATE OF DEATH          MBR DATE OF BIRTH        

BILL BATCH NO          DATE OF ADMISSION         

BILL BLOCK NO          BILLING PERIOD from date “to” date

 

INTERMEDIARY I.D. NO.         

C. Procedure for clearing HI System DOD Alerts for FOs and PSCs

Review the alert with the claims folder to resolve the DOD discrepancy. The necessary action by the field office (FO) or program service center (PSC) depends upon the evidence in file. For examples of acceptable proof of death, see GN 00304.005 through GN 00304.025.

IF evidence in file indicates

THEN

MBR DOD is incorrect

Correct the Master Beneficiary Record (MBR) via direct input to Manual Adjustment, Credit and Award Data Entry (MACADE).

HI record is incorrect

Annotate the alert and prong-file on the right side of the folder or document the case electronically if a CEF or EF is involved. Correct the HI system via direct input. For Correction of Date of Death on Health Insurance Records, see SM 00706.085 - SM 00706.100.

No proof of death

Request the FO to develop proof of death via the Modernized Development Worksheet (MDW):

 

  • Indicate that this is an MBR-HI discrepancy;

  • Record the DOD shown on the computer output in file and the DOD shown on the Part A bill (Document the case electronically if a Certified Electronic Folder (CEF) or Electronic Folder (EF) is involved);

  • If an FO previously transmitted termination with a “P” code, refer the request to that FO; include the original transmission date;

  • Diary the case for 30 days;

  • File the alert on the left side of the folder (or document the case electronically if a CEF or EF is involved) pending a reply;

  • If the results of FO development show that the MBR is incorrect, correct the MBR.

  • If the results of FO development show that the HI bill DOD is incorrect, correct the HI record per SM 00706.085; and

  • If you identify an underpayment or overpayment during this review, follow instructions for underpayments in GN 02301.001 or for overpayments in GN 02201.001.

NOTE: If the beneficiary is residing outside the United States, except Canada, Mexico, or Philippines, request proof of death via Modernized Development Worksheet (MDW). The U.S. Veterans Administration Regional Office in Manila is the servicing office for the Philippine addresses. For addresses of servicing offices for Canada and Mexico, see the Office of International Operations website/Resource Kit/Canadian-Mexican Service Area Directories (http://ocoweb.ba.ssa.gov/oio/OIOResources/CanMexDirect.asp ).