Use the following chart to determine when to process medical CDRs for beneficiaries
with tickets. Obtain this information from the “Ticket Use History” (TKUH) query in
the DCF. To close out the CDR, when appropriate, use standard procedures in DI 13005.020I.
IF
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THEN
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CDR initiated before ticket status was In-Use.
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CDR continues, unless the beneficiary alleges ticket use begin date is incorrect.
For In-Use begin date investigation, follow instructions in DI 55025.010A (in this section).
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Beneficiary alleges ticket In-Use.
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FOs or PCs check the DCF to see if CDR closed because of ticket. If contrary to allegation,
the ticket is Not-In-Use and the CDR is open, follow DI 55025.010A (in this section).
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OESP confirms beneficiary’s allegation of ticket use prior to CDR initiation date.
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OESP notifies the Program Manager to change ticket status to “In-Use” and the system
closes out CDR.
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OESP denies beneficiary’s allegation of ticket use.
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Process the CDR if the DCF still shows ticket “Not-In-Use”
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CDR not closed and ticket not In-Use.
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FO/PC sends notice of CDR. (For copy of notice, see NL
00705.350.)
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CDR closed out.
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FO/PC sends the CDR deferral notice. (For copy of notice, see NL 00705.355.)
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NOTE: If neither the beneficiary nor provider notifies us that the beneficiary was receiving
VR or employment support services and a medical CDR determination terminates benefits,
the cessation will stand even if we retroactively assigned the ticket prior to the
date of the determination.