Examine the claims folder to see if the State buy-in is reflected on a Form SSA-1596-C1,
Record Changes in Premium Deductions or Billing Status, or on a manually processed
debit action (SSA-2795-U3 or SSA-2652-U2) and that the data shown is in agreement
with that alleged and that on the MBR. If so, prepare a final reply to the correspondent.
If the MBR data and allegation are not in agreement and the folder contains no evidence
of any State buy-in coverage, forward the correspondence to the appropriate DO for
development. Acknowledge the referral except when the correspondence originated from
the DO. Use a Form 41 (see examples below for the information to be given to the DO).
No control is necessary.
Annotate the Remarks portion of the Form 41 as follows:
“Please review the attached correspondence and develop in accordance with HI 00815.088 and prepare any necessary reply because (insert (a) through (d) below or other explanation,
folder contains no evidence of buy-in coverage
folder contains evidence of buy-in coverage for the months .
folder shows continuous buy-in coverage by the State of beginning.
Processing center has no record for this person under this claim number.”
To determine the DO to be contacted, see HI 01001.205. In most buy-in States, a specific DO has been established for handling buy-in issues.
If folder documentation is consistent with the allegation but inconsistent with the
MBR data, forward the case to the Benefit Authorizer for action to record the State
buy-in on the MBR and to prepare all required notices.