DI 11052.025 Notices and Paragraphs for Initial End-Stage Renal Disease Medicare Cases
A. Award notices
When processing an initial claim through Earnings Computation (EC), the award notice is automatically generated based on the type of claim entered on the APPL screen and completion of the rest of the screens within the Modernized Claims System (MCS) path.
If the beneficiary is entitled to equitable relief, MCS notices automatically generate paragraphs HIB068 and HIB075.
When a copy of the notice is necessary due to third party involvement, entry on the NOT1 screen with a third-party’s name and address produces a copy of the notice to the third party and generates the COP001 on the beneficiary’s notice. The same is true if the case has an attorney or representative involved – EC generates the copy of the notice and the COP001 based on information from the NOT2 screen.
If you must include additional information in the notice, use the dictated notice paragraph HIBD01. Dictated language can be found in (DI 45001.076 through DI 45001.104)
B. Denial notices
For disallowances processed through Earnings Computation (EC) using code 109, you can use dictated paragraph HIBD01. Include the information from DI 45001.076 ESRD Medicare Disallowance as appropriate on the NOT3 screen.
If the denial notice cannot be requested through MADCAP, the technician will release a denial notice after the denial has posted to the Master Beneficiary Record (MBR).