BASIC (02-02)

DI 55002.035 Determining Why The System Did Not Select A Beneficiary/Recipient for A Ticket

A. Procedure – steps for FOs and PCs to take

1. Step 1 – interview the beneficiary/recipient

When the system did not select a beneficiary/recipient for a ticket and the individual wants to know why, interview him/her first. The requirements for ticket eligibility are found in DI 55002.005. The most common reasons for not getting a ticket are the individual:

  • does not live in a ticket location, as shown on SSA’s system (i.e., the MBR or SSR);

  • does not meet the 18 through 64 age requirement; or

  • is not now receiving a Federal cash disability/blindness-based payment from SSA.

2. Step 2 – obtain and review the MBR/SSR

When unable to determine from the interview why the beneficiary/recipient is not ticket-eligible, obtain and review the coding on the MBR/SSR (see DI 55002.035B and DI 55002.035C). Be sure to:

  • Examine each listed MBR/SSR field. There are two reasons to do this. First, there may be more than one reason the beneficiary/recipient did not get a ticket. Second, in some cases the programming for one ticket-exclusion criterion requires the checking of multiple fields.

  • In concurrent cases, obtain and review both the MBR and the SSR. To get a ticket, a concurrent beneficiary need be ticket-eligible on one record only (i.e., the title II or the title XVI record). Thus, if a concurrent beneficiary did not get a ticket, determine why the individual is ticket-ineligible on both records.

B. Procedure – reviewing the MBR in Title II cases

If the individual is a title II beneficiary, obtain an MBR query and review it to determine why the system did not select the individual's record. The following chart will help in this review. Be sure to examine each listed MBR field.

Guide for Reviewing an MBR Query When a Ticket Eligibility Question Arises

MBR DATA LINE

MBR FIELD

POSSIBLE REASON TICKET SELECTION NOT MADE

PAYMENT

SCC

A beneficiary living in a non-ticket location is not eligible for a ticket (see DI 55002.005C.8.).

During Phase 1, the first two digits of the SCC (State and County Code field (see SM 00510.096B.5.) must be one of the following for the title II record to be selected: 03, 06, 08, 10, 14, 16, 22, 33, 37, 38, 42, 47, or 52 (representing AZ, CO, DE, FL, IL, IA, MA, NY, OK, OR, SC, VT, and WI, respectively).

During Phase 2, the first two digits of the SCC must be one of the following for the title II record to be selected: 02, 03, 04, 06, 07, 08, 09, 10, 11, 14, 15, 16, 17, 18, 19, 22, 23, 25, 26, 27, 29, 30, 31, 32, 33, 35, 37, 38, 42, 43, 44, 47, 49, or 52 (representing AK, AZ, AR, CO, CT, DE, DC, FL, GA, IL, IN, IA, KS, KY, LA, MA, MI, MS, MO, MT, NV, NH, NJ, NM, NY, ND, OK, OR, SC, SD, TN, VT, VA, and WI, respectively).

During Phase 3 and later, the first two digits of the SCC must be one of the following for the title II record to be selected: 01 through 53, 97, 98, or 99 (representing the 50 States, DC, PR, VI, AS, GU, and MP).

NOTE: The SCC reflects the mailing address of the beneficiary or his/her representative payee or legal representative. See DI 55002.045B.1. when a title II beneficiary resides in a ticket location but the mailing address for the beneficiary or his/her representative payee or legal guardian is in a non-ticket location.

BENEFIT

BIC

An individual must be entitled to a disability-based benefit to be eligible for a ticket (see DI 55002.005B.2.).

For the title II record to be selected, the BIC (beneficiary identification code) field (see SM 00510.150B.1.) must display an A, C, or W (see SM 00550.010B.).

If the BIC is A, the TAC (type of award code) field in the ACCOUNT data line (see SM 00510.070B.10.) must display a D.

If the BIC is C or W, the CEC (current entitlement code) field in the BENEFIT data line must display a B.

BENEFIT

DOB

A beneficiary who is under age 18, or is age 65 or older, is not eligible for a ticket (see DI 55002.005B.1.). Thus, the DOB (date of birth) field (see SM 00510.150B.4.) must indicate that the beneficiary is at least age 18 and not yet age 65 for the title II record to be selected.

BENEFIT

LAF

If benefits have been terminated or are in suspense or deferred status, the beneficiary is not eligible for a ticket (see DI 55002.005C.1.). Thus, the LAF (ledger account file) field (see SM 00510.150B.8. and SM 00550.020B) must display a C for the title II record to be selected.

DIB INV

RDI

A beneficiary receiving 301 payments is not eligible for a ticket (see DI 55002.005C.2.). Thus, if the RDI (reason for disability investigation) field displays a K (see SM 00510.300B.12.), the title II record will not be selected.

NOTE: A code of K indicates that the beneficiary receives section 301 payments.

DIB INV

MDR

Beneficiaries with MIE diaries are not eligible to receive a ticket until they have had at least one medical CDR and receive a final disability determination that disability continues or have been on the disability rolls for at least 3 years (see DI 55002.005C.4.). Thus, if the MDR (medical diary reason) field (see SM 00510.300B.17.) displays an alpha code (indicating a MIE diary, see DI 26525.025B) or is blank (indicating there is no established diary on the system), one of two things must be present for the title II record to be selected. One is that the date in the DOEC (date of current entitlement) field of the BENEFIT data line (see SM 00510.150B.6.) must be more than 3 years prior to the current date. The other is that the CDRCF (continuing disability review file) must show there has been a medical continuance decision.

There has been a medical continuance if there is a “continuance” event on the CDRCF for a CDR record type of “1” (T16 Medical), “4” (LWB/CHLD/18), or “5” (T2 Medical). The ECDR screen of the CDRCF displays the most recent history data event. To get there, select 32 (Continuing Disability Review File) on the SSA Main Menu. Then, from the MCDR screen, select 1 (Query) and enter the SSN or SSN and BIC. The QCDR screen(s) provides a historical record of all events entered on the CDRCF. To get there, select 1, 4, or 5 from the ECDR screen.

NOTE: See MSOM 185-A, MSOM 185-B, and MSOM 185-C for more information about these CDRCF screens.

BEN REF

BOAN

A beneficiary must have a social security number to get a ticket (see DI 55002.005C.9.). Thus, if the BOAN (beneficiary's own account number) field (see SM 00510.450B.2.) does not display an SSN when the BIC in the BENEFIT data line (see SM 00510.150B.1.) is a W or a C, the title II record will not be selected.

DIB

DOED

An individual must be entitled to a disability-based benefit to be eligible for a ticket (see DI 55002.005B.2.). Thus, the DOED (date of entitlement to DIB) field (see SM 00510.460C.5.) must contain a month and year entry for the title II record to be selected.

DIB

PRY

A beneficiary receiving benefit continuation payments while appealing a medical cessation is not eligible for a ticket (see DI 55002.005C.3.). Thus, if the PRY (pending appeal review) field (see SM 00510.460C.9.) displays a code of A or B, the title II record will not be selected.

NOTE: A PRY code of A or B indicates the beneficiary has an appeal pending on a medical cessation determination.

DIB

DBC

An individual must be entitled to a disability/blindness-based benefit to be eligible for a ticket (see DI 55002.005B.2.). Thus, the DBC (disability benefit cessation) field (see SM 00510.460C.11.) must be blank or display a date greater than the current month for the title II record to be selected.

HISTORY

WIC

An individual receiving provisional (temporary) cash benefits under the EXR provisions is not eligible for a ticket (see DI 55002.005C.6.). Thus, if the most recent WIC (work indication code, see SM 00510.520C.5.b.) is a P, the title II record will not be selected.

NOTE: The WIC code is the second position of the Status Code field. A code of P in this position indicates that the individual is receiving provisional (temporary) cash benefits under the EXR provisions.

C. Procedure – reviewing the SSR in Title XVI cases

If the individual is a title XVI recipient, obtain an SSR query and review it to determine why the system did not select the individual's record. The following chart will help in this review. Be sure to examine each listed SSR field.

Guide For Reviewing An SSR Query When A Ticket Eligibility Question Arises

SSR

SEGMENT

SSR

FIELD

POSSIBLE REASON TICKET SELECTION NOT MADE

Standard Response Data

ID

An individual must be eligible for SSI benefits based on disability or blindness to be ticket-eligible (see DI 55002.005B.2.). Thus, for the title XVI record to be selected, the code in the ID (individual recipient identification) field (see SM 01601.430C.7.) must be a DI, DS, DC, BI, BS, or BC.

CRZD

CG

An individual receiving provisional (temporary) cash benefits under the EXR provisions is not eligible for a ticket (see DI 55002.005C.6.). Thus, if there is a code of EXRE in the CG (case characteristic data) field (see SM 01601.460C.1.), the title XVI record will not be selected.

NOTE: EXRE is entered in the CG field when an individual is receiving provisional (temporary) cash benefits under the EXR provisions (see SM 01701.080C.).

PRSN

DB

A recipient who is under age 18, or is age 65 or older, is not eligible for a ticket (see DI 55002.005B.1.). Thus, the DB (date of birth) field (see SM 01601.475C.6.) must indicate that the recipient is at least age 18 and not yet age 65 for the title XVI record to be selected.

PRSN

DB

&

DOE

A recipient who receives SSI disability payments based on the childhood standard is not eligible to receive a ticket (see DI 55002.005C.5.). Thus, if the date in the DB field (see SM 01601.475C.6.) is after August 22, 1978 (i.e., the recipient attained age 18 on or after August 22, 1996), and the DOE (date of eligibility) (see SM 01601.475C.16.) is prior to the date the individual attained age 18, check to see if the individual has had an age-18 redetermination and been found eligible based on the adult disability standard.

To do this, look at the CDR field of the DISB segment (see SM 01601.595C). If an event type of “3” or “4” is not displayed, the individual has not had an age-18 redetermination and the title XVI record will not be selected. If an event type of “3” or “4” is displayed, check the QCDR screen of the CDRCF. The QCDR screen must display “Age 18” in the category field and a “continuance” in the event field for the title XVI record to be selected.

To get to the QCDR screen of the CDRCF, first select “32” (Continuing Disability Review File) on the SSA Main Menu. Next, select “1” (Query) and enter the SSN from the MCDR screen. Then, select “3” (PL 104-193) or “4” (LBW/CHLD/18) from the ECDR screen.

NOTE: See MSOM 185-A, MSOM 185-B, and MSOM 185-C for more information about these CDRCF screens.

ADDR

ST

A recipient living in a non-ticket location is not eligible for a ticket (see DI 55002.005C.8.).

During Phase 1 , the first two digits of the ST (State and County Code) field (see SM 01601.535C.) must be one of the following for the title XVI record to be selected: 03, 06, 08, 10, 14, 16, 22, 33, 37, 38, 42, 47, or 52 (representing AZ, CO, DE, FL, IL, IA, MA, NY, OK, OR, SC, VT, and WI, respectively).

During Phase 2 , the first two digits of the ST must be one of the following for the title XVI record to be selected: 02, 03, 04, 06, 07, 08, 09, 10, 11, 14, 15, 16, 17, 18, 19, 22, 23, 25, 26, 27, 29, 30, 31, 32, 33, 35, 37, 38, 42, 43, 44, 47, 49, or 52 (representing AK, AZ, AR, CO, CT, DE, DC, FL, GA, IL, IN, IA, KS, KY, LA, MA, MI, MS, MO, MT, NV, NH, NJ, NM, NY, ND, OK, OR, SC, SD, TN, VT, VA, and WI, respectively).

During Phase 3 and later, the first two digits of the ST must be one of the following for the title XVI record to be selected: 01 through 53, 97, 98, or 99 (representing the 50 States, DC, PR, VI, AS, GU, and MP).

DIAR

Diary

Code

An individual receiving provisional (temporary) cash benefits under the EXR provisions or one receiving 301 payments is not eligible to receive a ticket (see DI 55002.005C.6. and DI 55002.005C.2., respectively). Thus, if a diary code (see SM 01601.580C.1.) of PP or VP appears, the title XVI record will not be selected.

NOTE: A diary code of PP indicates the individual is receiving provisional (temporary) cash benefits under the EXR provisions (see SM 01701.080C). A diary code of VP indicates the individual receives section 301 payments.

DISB

DPC

An individual receiving provisional (temporary) cash benefits under the EXR provisions or presumptive disability or blindness payments is not eligible to receive a ticket (see DI 55002.005C.6. and DI 55002.005C.7., respectively). Thus, if the DPC (disability payment code) field does not display an F or an S, the title XVI record will not be selected.

NOTE: A code of F in the DPC field indicates a final medical allowance. A code of S in the DPC field indicates a State determination on a conversion case.

DISB

MG

A recipient receiving benefit continuation payments while appealing a medical cessation is not eligible for a ticket (see DI 55002.005C.3.). Thus, if the MG (medical recovery) field (see SM 01601.595C) displays a code of T and there is no indication of an appeal reversal, the title XVI record will not be selected.

NOTE: The system presumes there has been an appeal reversal when the APPE (Appeals Data) segment (see SM 01601.685C) displays the following four elements. First, there must be a code of P in the appeal type (T) field. Second, there must be a blank or a code of MC or DR in the appeal reason (RSN) field. Third, the appeal filing date (FIL) must be later than the date that appears after the T code in the MG field of the DISB segment. Fourth, there must be a code of FC, FF, or PF in the appeal decision (DSN) field.

DISB

MDR

Recipients with MIE diaries are not eligible to receive a ticket until they have had at least one medical CDR and received a final disability determination that disability/blindness continues or have been on the disability rolls for at least 3 years (see DI 55002.005C.4.). Thus, if the MDR (medical diary reason) field (see SM 01601.595C) displays an alpha code (indicating a MIE diary, see DI 26525.025B) or is blank (indicating there is no established diary on the system), one of two things must be present for the title XVI record to be selected. One is that the date in the DOE (date of eligibility) field of the PRSN (Person Related Data) segment (see SM 01601.475C.16.) must be more than 3 years prior to the current date. The other is that the SSR or CDRCF must show there has been a medical continuance decision.

One indication that there has been a medical continuance is if the CDR field of the DISB segment of the SSR (see SM 01601.595C) displays an event type of “1”, “4” or “5” and an event code of “011”. Another indication that there has been a medical continuance is if there is a “continuance” event on the QCDR screen of the CDRCF for a CDR record type of “1” (T16 Medical), “4” (LWB/CHLD/18), or “5” (T2 Medical).

To get to the QCDR screen of the CDRCF, first select “32” (Continuing Disability Review File) on the SSA Main Menu. Next, select “1” (Query) and enter the SSN from the MCDR screen. Then, select “1”, “4”, or “5” from the ECDR screen.

NOTE: See MSOM CDR 001.002, MSOM 185-B, and MSOM 185-C for more information about these CDRCF screens.

CMPH

FAM

If no Federal cash disability/blindness-based SSI benefit is payable, the recipient is not eligible for a ticket (see DI 55002.005C.1.). Thus, the amount in the FAM (Federal Amount Due) field (see SM 01601.790C.2.) must be greater than “.00” for the title XVI record to be selected.

CMPH

PS

If no Federal cash disability/