To help insure the continuing integrity of the PEPPER program, the Exception and Inquiries
Examiner in all offices will review all of the processed forms HCFA 2688/2688A (premium-HI)
output. The review will be performed as described below.
The Great Lakes and Mid-America Program Service Centers and ODO will be responsible
for the validation of the Forms HCFA L325/325A and HCFA-L326/ 326A (SMI coverage)
produced by the PEPPER program. This program will select a limited number of these
cases for the Great Lakes and Mid-America Program Service Centers and ODO and annotate
the output as “SAMPLE REVIEW CASE.”
The basic purpose of this review is the early detection of possible program errors
such as incorrect termination dates, payment amounts, premiums, etc. All such errors
should be brought to the immediate attention of the Director of Operations (ODO should
notify the Operations Support Staff) who will notify, as soon as possible, Office
of Claims and Payment Requirements, Division of RSDI Postentitlement Systems, Health
Insurance, Correspondence, and Critical Case Branch by telephone or memorandum.
The output will reflect the following data:
The name and address of the claimant whose entitlement has been terminated will be
The date of preparation will be shown.
The claimant's claim number will be shown.
Folder Location Indicator
The folder location indicator will be displayed on the folder documentation only.
Forms HCFA-L325 and 326 will show the last day of the last month and year of coverage;
e.g., January 31, 1977.
Form HCFA-2688 will show the month and year of the last month of coverage; e.g., December
Premium Amount Due (Forms SSA-L326 and 2688 only)
The amount of unpaid premiums through the last month of coverage will be shown.
The computer run (processing) date.
This is the month and year the action was recorded on the MBR.
The last debit action block number from the MBR.
The new ABN assigned by the PEPPER program as a result of this action. The number
always has four digits.
Payment Discontinued (Date and Amount, HCFA-L325A Only)
For insured beneficiaries in current pay status, these entries will reflect the credit
month (date) and the monthly benefit amount that was being paid.
CMA-THRU (Date and Amount, HCFA-L325A Only)
The month and the amount of the CMA check being paid for claims in current pay status.
Payment Change (Date, Old MBP HCFA-L326A Only)
For insured beneficiaries in nonpayment status, these entries reflect the update month
and the adjusted monthly benefit payment amount prior to the withdrawal action. The
appropriate BIC will be printed in front of the money amount.
The BIC of the claimant whose coverage has been terminated.
The current MBA will be shown for all insured cases. The block will be blank for uninsured
For insured cases only, the MBP will be increased to the MBA amount.
Additional Processing Data
A remark will appear if the individual's premiums were paid beyond the last month
of coverage and the program generated a refund (for SMI coverage) or a refund is due
(for premium-HI coverage). The program will always pay a SMI refund in a separate
check. The program will never generate a premium-HI refund.
NOTE: If a premium-HI refund is indicated as being due and the review verifies that the
remark is correct, process a Special Indicator Card with an Action Indicator of “A”.