BASIC (09-08)

DI 52155.025 A101 Processing Claims with Workers' Compensation/Public Disability Benefit (WC/PDB)

Disability claims may require manual processing because of systems limitations in MCS EC. In most cases, these claims are processed using an A101. The WC/PDB offset determination is connected to the A101 in one of the following two ways.

A. MCS EC provides the WC/PDB offset determination

  • If MCS EC screens provide computations, WC/PDB data will propagate to the A101.

  • Verify that the results are correct and the benefit amounts on the MBEN correctly reflect the AMT PAYABLE AFT OFFSET.

  • No further action is necessary for WC/PDB processing and the A101 can be completed.

B. MCS EC does not provide WC/PDB offset determination or determination is not correct

  1. Before starting the A101 complete the WC/PDB offset determination in the T2 Interactive Computation Facility (ICF) #32 WC/PDB: ADJUDICATE CLAIM or #34 WC/PDB: ONLINE RECORD ENTRY.

    NOTE: SEE DI 52165.001 for information on using ICF for WC/PDB offset determination. To use with an A101, the following entries are critical:

    • Answer “Y” to IS THIS COMPUTATION FOR AN A101/MANUAL AWARD? on the WCPA screen.

    • If auxiliaries are being adjudicated on the A101 use the WCSP and WCCH screens to provide that information.

    • Provide WC/PDB notice information on the WCNM screen to be used in connection with the A101.

    • Answer “Y” to ADJUDICATE WC/PDB CLAIM on the WCDA screen. When used in connection with an A101, this does not send the action to T2R for processing, but makes it available for MACADE.

  2. Prepare the A101 after the ICF #32 or #34 WC/PDB offset determination is adjudicated.

    NOTE: The WC/PDB Common screens are included in the A101 path.

    • When the NH is being adjudicated on the A101, enter “Y” in USE RESULTS FROM ICF on the A101 WRAC screen.

    • When only auxiliaries are being adjudicated on the A101, enter “Y” in WC/PDB OFFSET DATA ON ICF on the A101 ACCT screen.

    • The WC/PDB results screens and the MBEN screen will reflect the MBA information before offset.

    • The Benefit Authorizer/Benefit Technical Examiner (BA/BTE) will use the ICF #32 or ICF #34 screens to propagate WC/PDB offset results and benefit amounts after offset into MACADE when the A101 includes instructions to use ICF results.

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DI 52155.025 - A101 Processing Claims with Workers' Compensation/Public Disability Benefit (WC/PDB) - 06/28/2013
Batch run: 06/28/2013