HI 00825.070 Undeliverable SMI Premium Notice

When a premium notice, CMS-500, is returned as undeliverable for address reasons, the Exceptions and Inquiries Examiner must examine the claims folder.

In examining the folders, look for such things as a later address, prior development of a later address, change in payment status since the notice was mailed, etc.

Based on what is found in the file, handle as follows:

1. A. 

   If there is a more current address, remail the billing notice to the later address.

2. B. 

   If there is no later address and no prior development of a better address, use the Processing Center Action Control System (PCACS) to request assistance from the DO. Provide the DO with any information in the file which may aid them in locating the claimant. A good example of additional information would be a recent third party buy-in or buy-out. This will prompt the DO to check the State agency, etc.

3. C. 

   If there was a prior unsuccessful development to locate the claimant at the address shown on the premium notice and there has been no change in status or no additional information available since that development, file the notice in the claims folder annotating the disposition on the notice.

4. D. 

   If the returned notice is an HCFA-40 sent to an uninsured claimant (including special age 72 beneficiaries) and there is no later address in the claims folder, file the notice. Take no action to develop as it would duplicate the automatic DO contact generated by the SOBER system.

   In those instances outlined above in which it is necessary to develop through the DO, use the Processing Center Action Control System (PCACS) to request assistance. Send it along with the notice to the DO servicing the address shown on the returned notice. The servicing office can be determined by the city and State of residence and by reference to the Geographic Code Book. No control need be maintained for these requests.

   In the event the DO subsequently advises that they are unable to locate the individual, no further action need be taken. Annotate the notice as “undeliverable” and forward it to the Records Analysis Clerk to be filed in the claims folder.