TN 1 (11-00)
DI 12548.030 Processing Payment Actions after Favorable Adjudication – Title II
After a favorable title II adjudication, payment must be processed as expeditiously as possible, applying all appropriate deductions, offsets, and fees.
2. System Process
Claims are District Office Final Authorization (DOFA).
Title II awards are input through MCS. MCS processing exclusions must be sent to the PC for Manual Adjustment Credit and Award Processing (MADCAP).
For ODAR cases, normal procedures are followed for processing awards based on ALJ or Appeals Council decisions.
1. Compute Benefits
To compute benefits, consider the following:
Medicare premiums - Consider state buy-in provisions. If it appears that the claimant will be liable for over 6 months of retroactive Medicare premiums, initiate equitable relief development (see HI 00805.170 ff.). Do not delay adjudication pending resolution of the equitable relief issue. If the issue is still pending when the claim is forwarded to the PC, indicate that fact on the SSA-3601.
Overpayments - apply normal rules.
Attorney fees - apply normal attorney fee withholding rules.
Offsets - apply normal rules.
If a fully favorable medical determination/decision was issued based on the alleged onset date of the earliest Hyatt III claim either because of a subsequent application or a previous Hyatt III reopening, the DDS/ODAR adjudicator completed a Favorable Determination/Decision Worksheet and Transmittal (see DI 12548.095, Exhibit 13)
Verify payment. If no additional benefits are payable, prepare and release the notice “No Benefits Payable” (see DI 12548.095, Exhibit 12). If the earliest application filed within the Hyatt III period is not a Hyatt III eligible claim, include the optional paragraph found in DI 12548.025A.1.
Release the notice to claimant, claimant's representative, if any class counsel and the Litigation Staff.
Retain the folder during the appeals period.
Prepare A101 or EF101 for PC processing. Show "Hyatt Court Case" in item 11.
Route the case to PC under cover of SSA-3601. Check "Other" block and enter in "Remarks" that "Process case per DI 42548.001 ff."
3. Continuances or earlier onset established
Take the following actions when a cessation is reversed to a continuance or an earlier onset date is established.
Process for benefit payments for the retroactive period.
Route the folder(s) to the PC via an SSA-3601. Check the “other” block and indicate in “Remarks” that the DDS notice language is in the folder.