Prepare a barcode fax coversheet to submit forms SSA-892 (End Stage Renal Disease
(ESRD) Medicare Determination) and CMS-2728 (End Stage Renal Disease Medical Evidence
Report) into the Non Disability Repository for Evidentiary Documents (NDRed), when
processing is complete.
If PC action is required, create an actionable fax Paperless barcode coversheet, select
document type “Claim ESRD PC7-Initial Claim-ESRD PC7/DAC” and the Additional Information
“ESRD Claim” and include the SSA-892 and CMS-2728 and fax to PC7 via the Paperless
Processing Center (PPC).
For adult children age 22-26, filing for ESRD Medicare using a parent’s insured status
refer to DI 1102.005E. For CEF exclusions, forward the brown folder under the appropriate
routing form to the Office of Disability Operations (PC7), 1500 Woodlawn Drive, Baltimore,
MD 21241, when processing is complete.
NOTE: If manual action needed, do not fax forms into NDRed. It is Office Disability Operations