If there is an existing CEF (pending or closed), the CR verifies ESRD entitlement
and processes the claim according to current procedures. Additionally, the CR:
Completes the End Stage Renal Disease (ESRD) Medicare Determination Form SSA-892-U2
per HI 00801.308 Preparing the SSA-892-U2;
Creates a barcode coversheet for Form SSA-892-U2 using document type code 0113 – ESRD
Creates a barcode coversheet for Form CMS-2728-U3 using document type code 0114 –
ESRD Medical Evidence Report;
Faxes both the SSA-892-U2 and the CMS-2728-U3 into the CEF using the barcode coversheets
per DI 81010.090 Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes;
If ODO action is needed fax form SSA-3601 Claims Routing Form to PC7 via the Paperless
Processing Center (PPC) system using Fax number (877) 385-0643; and
NOTE: This alerts ODO that there is an issue pending. The faxed Form SSA-3601 should display
the proper TOEL – “CLAIM ESRDINT” and a remark – “Manual Action Required. See SSA-892
in Section A and CMS-2728 in Section F of eView”.
Inputs the adjudicative decision and PC-7 jurisdiction on the Decision Input (DECI)
NOTE: Use Non-EC Clearance when transferring the MCS segment to PC-7 for manual processing
of the ESRD award.
In some cases, a CEF exists for a claimant in a terminated status (e.g., LAF – T8,
or X7). If the ESRD award action can be processed to completion (LAF change to “U”)
by the Field Office via MCS EC, skip the 5th and 6th bullets as shown in DI 81010.144C. above, as this requires no ODO MACADE action.