HI 00825.001 HI/SMI Inquiries Received from Beneficiaries
All complaint correspondence pertaining to or arising from SMI premiums (i.e., billing,
termination, or premium collection activity) or HI/SMI in general are directed to
the Exceptions and Inquiries Examiner. The examiner will handle a variety of complaints
and inquiries relative to an enrollee's HI/ SMI status and SMI premium deduction and
Generally, the responsibilities involve a determination as to the proper action to
be taken and, if applicable, replying to the correspondence received.
The following sections are intended to fully explain the methods to be employed in
reconciling most HI/SMI inquiries received in the program service center. It is expected
that the relatively small number of situations not covered by these procedures will
be effectively handled based on the guidelines set out below.
Although the instructions in the following sections will enable an accurate handling
of correspondence, other chapters of the POMS dealing with HI correspondence should
be the tool used to effectively analyze the claims folder in each situation. In all
cases, except as outlined below, a reply to an inquiry must be made.