TN 3 (01-07)

DI 13050.095 Processing Center Expedited Reinstatement (EXR) Procedures

A. Background

The FO or TSC will screen an individual who inquires about EXR and take necessary action using the policies and procedures in DI 13050.001 and DI 13050.045 OCO/PC action can be necessary:

  • When a previous termination decision has been made but not yet input into the system. Provisional payments can not begin until the prior termination has been effectuated (see DI 13050.025C.2.).

  • When the FO cannot initiate provisional benefits due to a systems limitation (see DI 13050.025I.3.);

  • When the EXR decision is made (see DI 13050.045C.2.);

  • In processing award actions (EF-101) related to EXR (see DI 13050.060C.);

  • In processing suspension payment actions related to the IRP in direct input exclusion cases (see DI 13050.066); and

  • In overpayment processing (See DI 13050.080).

EXR award and denial processing are high priority actions. It is important that OCO/PC work closely with the field to quickly resolve any issues that may delay the processing of EXR requests or decisions. This is especially important when an individual is requesting EXR but the prior termination has not yet been effectuated on the system, as provisional payments can not begin until the previous benefits have been terminated.

Requests relating to provisional benefits and to denial of EXR will normally be received by OCO/PC through the MDW system with a code of “2560HP” (or through OCO telephone procedure). Award actions will normally be received through a special FAX number.

B. Procedure

OCO takes priority action on provisional benefits when an alert is received based upon FO input, or on an FO phone call, or an award decision is made or received in OCO. Other PCs take priority actions on provisional benefits when an alert is received based upon FO input, the FO requests action via an MDW, or an award decision is made or received in the PC.

Process award actions as follows:

  • Perform cursory review of the EF-101.

  • Call the FO if necessary to resolve any folder-based issues.

  • Terminate provisional benefits, if necessary, and process disability reinstatement per instructions in SM 00856.300 through SM 00856.400.

  • The EXR entitlement is indicated with a new DIB line on the MBR. This new line should include a DOED showing the first month the person is due benefits under EXR. The DDO is the last day of the month prior to the DOED. Ensure DAC of “F” is coded, which indicates an EXR case (see SM 00856.300B.1.).

  • Adjust for provisional benefits paid and Medicare issues.

    NOTE: Medicare reinstatement action should consider new initial enrollment period (IEP) and equitable relief provisions as appropriate.

  • Send the reinstatement notice to the beneficiary. The EXR award notice is available in DPS and Aurora. See NL 00703.956 for the sample notice. Use the procedures in DI 13050.060 to prepare needed award forms for EXR cases.

  • Clear the EXR event in the DCF as a “continuance” per DI 13010.625B.

C. Process

OCO/PC processing of actions relating to EXR provisional payments, Medicare, and reinstatement allowance and denial processing are in SM 00856.100 to SM 00856.400. EXR Notices are available in DPS and Aurora.

D. Policy - TOEL for EXR and Provisional Benefits

The following are PCACS TOELs to use in EXR processing:

1. DIPROV Payment

This combination will be used when a claimant is requesting reinstatement and Provisional Benefits have been initiated.

2. DIPROV TERM

This combination will be used when a DDS decision is received showing that the claimant is NOT entitled to reinstatement under EXR, and we must terminate provisional payments. This combination will also be used when the six-month provisional payment period has expired, and for termination of provisional payments due to FRA Attainment or SGA.

3. DIPROV Resume

This combination will be used when a DDS decision is received