HI 00815.073 SSA DO/BO Assistance to States

A. General

Although CMS initiates buy-in accretions under the SSI program for individuals in an auto-accrete State, most States will make buy-in eligibility determinations for some or all claimants. There will be occasions when the State will ask the DO/BO for assistance in identifying an individual.

When the State decides to enroll a person under a buy-in agreement, the State must furnish the individual"s social security or railroad claim number and buy-in effective date to CMS as part of the accretion record. CMS screens the incoming transaction. If CMS cannot identify the individual or verify his eligibility, CMS will reject the item and return it to the State.

When the State receives the reject it reviews its records to determine whether the claim number and other identifying information was input correctly. If the State determines that its original input record was incorrect, it will resubmit the transaction using the correct data.

However, if the information submitted on the original accretion is correct according to State files, the State will request assistance from the parallel DO directly or from the servicing DO/BO through the local welfare offices.

In addition, to requests to verify the claim number or other identifying information, the State may request DO/BO assistance in investigating possible erroneous death deletions or termination of Medicare entitlement. The State may also ask the DO/BO to establish the individual"s claim number in the unearned income field on the SDX (see HI 00815.036B, SM 02001.040, and SM 01301.325). The DO/BO should be responsive to the requests from the State so that the integrity of the buy-in record can be maintained.

B. DO/BO Action Upon Receipt of Request for Buy-In Information

The DO/BO, which received the request to verify the individual"s identity or eligibility for buy-in should maintain control of the item and develop a response either through its own initiative or by an SSA-562-U3 “Request for Assistance/Certification of Document(s)” and reply to the State or local welfare office which submitted the request.

The following types of information may be furnished to the State or welfare office as a result of development undertaken by the DO/BO.

1. NAME, SEX, AND DATE OF BIRTH

If any of these data are incorrect, furnish the correct data and advise the State to accrete under code 62.

2. CLAIM NUMBER

If it is found that the claim number in the State records is incorrect, furnish the correct claim number and advise the State to accrete under code 62.

3. NEW SSN

If no SSN is shown and the DO/BO has no record on microfiche for the individual, use the State"s request as a lead to solicit an appropriate claim; if necessary, assign an SSN; and request the earnings record. See 6 below.

4. INDIVIDUAL APPEARS TO BE ELIGIBLE FOR SMI

Determine whether the individual is eligible for SMI. In buy-in situations a State can enroll an individual at any time, i.e., enrollment periods are superseded.

  1. If the individual is currently eligible, treat the State"s request as a lead and process in accordance with 6 below.

  2. If DO/BO records indicate that a claim was forwarded to the PSC in which all factors of entitlement were met, but the individual refused Part B , advise the State to submit an accretion. The buy-in accretion will override the “R”, “T” , or “W” coding in the SOC field.

5. INDIVIDUAL CLEARLY INELIGIBLE FOR SMI

If the individual clearly is not eligible, i.e., is not old enough, does not meet alien residency requirements, or does not meet other factors of entitlement, notify the requesting office.

6. CLAIM FOR MONTHLY BENEFITS OR HOSPITAL INSURANCE BENEFITS PENDING OR RECENTLY FORWARDED TO THE PROGRAM SERVICE CENTER (PSC)

  1. If the individual appears eligible for SMI and no claim has been filed, obtain an application. When development is complete annotate the award form for a PW item per HI 00815.030. Notify the State of the date the award was forwarded to the PSC and that the State will receive a code 1167 accretion. This procedure also applies to a claim pending in the DO/BO when the request for assistance is received.

  2. If a claim for SMI was recently forwarded to the PSC but was not coded as a PW item, advise the State to accrete the individual to buy-in with a code 62. The code 62 will orbit in the Third Party System for up to 3 months pending establishment of the MBR and HI records.

The DO/BO can check on the status of