TN 31 (06-04)
HI 00801.300 District Office Final Authorization (DOFA) of ESRD Medicare Awards and Disallowances
Authority for field office (FO) authorization includes all ESRD Medicare awards and disallowances with the exception of the exclusion in HI 00801.300B. The FO will review the CMS-2728-U3 to determine whether the case involves dialysis only, self-dialysis training or transplant. The following sections provide instructions for establishing entitlement on the Master Beneficiary Record (MBR) and Enrollment Data Base (EDB) and processing determinations of disallowance.
Review the entries on the CMS-43/MCS screen and CMS-2728-U3 for consistency. If there are discrepancies, process as described in HI 00801.233I.
Do not make the final authorization decision when a determination of disability prior to age 22 for a dependent child is required (HI 00801.201C.3.).
Complete items 1 through 18 of Form SSA-892-U2 (End Stage Renal Disease (ESRD) Medicare Determination) (HI 00801.308) and process as a NON-DOFA action under conspicuous characteristic No. 19 (GN 01010.000). Forward to: the Disability Determination Services (DDS).
2. Preparation and routing of ESRD claims folder
Take the following actions in preparing and routing an ESRD claims folder:
Enter “ESRD” below the upper right edge of the folder for identification purposes.
After the processing actions indicated in the following sections have been completed, mail the folder(s) to the DDS.