Effective Dates: 07/31/2012 - Present Previous | Next

TN 9 (10-93)

RS 00208.115 Medicare - Development and Forwarding of Claims - Mothers/Fathers

A. Policy

To qualify for Medicare, a mother/father must establish that she/he meets all the requirements for DWB. Therefore, a mother/father seeking Medicare based on deemed DWB entitlement, must submit proof of age and evidence of disability in the same manner as if he/she were applying for DWB (see RS 00207.007 - RS 00207.008).

The routing of claims material after adjudication or development has been completed is discussed below.

B. Procedure - Initial Claims for Mother’s/Father’s Benefits Deemed DWB for Medicare

For initial claims for mother's/father's benefits deemed DWB for Medicare:

  • •

    Process the mother's/father's claims in the usual manner. Enter on remarks screen in the MCS claims path, “I am applying for DWB for Hospital Insurance purposes only.”

  • •

    Inform the claimant that he/she will be advised about the disability determination and entitlement to Medicare when a decision is reached.

  • •

    Create the DWB claim in the Electronic Disability Collect System (EDCS) as an MCS exclusion case.

  • •

    Route all disability material in accordance with the instructions in DI 11015.015.

C. Procedure - Mother/Father on the Rolls

1. Requests Actual Entitlement to DWB

For requests for actual entitlement to DWB:

  1. a. 

    Forward all material to the State DDS or ODO as indicated in RS 00208.115B.

  2. b. 

    Prepare an automated 101 (A101) for the DWB award indicating on the BCRN screen that mother's/father's benefit must be terminated and show the effective date for termination, if the claimant is found entitled as a DWB.

2. Requests Deemed Entitlement to DWB for Medicare

For requests for deemed entitlement to DWB for Medicare, forward the Form SSA-3368-BK and related disability evidence either to the State DDS or ODO as indicated in RS 00208.115B.

3. Deemed Entitlement to DWB for Medicare but Requests Payment as DWB

When claimant has deemed entitlement to DWB for Medicare but requests payment as DWB.

  1. a. 

    Obtain an SSA-10-BK.

  2. b. 

    Prepare an electronic form 101 (EF101) for the DWB entitlement. Indicate on the EFBCRN screen “DEEMED DWB FOR HI, Applying for Actual DWB.”

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0300208115
RS 00208.115 - Medicare - Development and Forwarding of Claims - Mothers/Fathers - 07/31/2012
Batch run: 07/31/2012
Rev:07/31/2012