Effective Dates: 11/23/2001 - Present Previous | Next

TN 2 (02-91)

HI 00901.125 Processing Undeliverable Health Insurance Cards and Enrollment Packages

A. BACKGROUND

Undeliverable HI cards and enrollment packages and those returned to CMS marked “deceased” must be developed for additional considerations. These include:

  • •

    delayed receipt of benefit checks,

  • •

    potential survivor"s benefits,

  • •

    termination of monthly benefits, and,

  • •

    termination of Part A and/or Part B.

Development timing is critical for Part B enrollment, refusal, and premium payment.

B. PROCEDURE

1. CMS Action

This table describes the action necessary for CMS"s development of undeliverable and “deceased” HI cards and enrollment packages.

Step Action
1 Secure current MBR printout.

2

Use the following to develop the case in new address situations.

  • •

    If a new address has recently been posted to the MBR, remail the material.

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    If a new address cannot be determined,send the material under cover of transmittal form HCFA-1725 (check item 10) to the appropriate PC.

3

Use the following to develop the case when death is involved.

  • •

    If the fact and date of death has been annotated to the MBR, destroy the material.

  • •

    If the fact and date of death cannot be substantiated, forward the material with a current MBR printout to the servicing FO for development.

4 For foreign beneficiaries for whom a correct address or substantiation of death cannot be found, forward all returned HI cards, forms HCFA-1739 and CMS-40-F with a current MBR printout to the Office of International Operations (ODIO/OIO).

2. PC Action

This table describes the action necessary for PC development of undeliverable and “deceased” HI cards and enrollment packages.

Step Action

1

Examine the claims folder for a better address.

  • •

    If a new address cannot be determined,request the servicing FO to develop. Include any current folder information which may help in locating the beneficiary.

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    If a new address can be determined, input to the MBR and release the material to the beneficiary.

2 If the death is verified, input to the MBR,and destroy the material.

3. ODIO/OIO Action

This table describes the action necessary for ODIO/OIO development of undeliverable and “deceased” HI cards and enrollment packages.

Step Action
1 Develop by correspondence, consular contact,etc. to determine beneficiary status.
2 If a new address is located, remail the material.
3 If death is substantiated, destroy the material.
4 Input to the MBR any pertinent postentitlement information.

4. FO Action

This table describes the action necessary for FO development of undeliverable and “deceased” HI cards and enrollment packages not resolved in CMS or the PCs.

Step Action
1 Attempt to locate the beneficiary. If successful, deliver or mail the card or enrollment package.
2 If death is verified, destroy the material.
3 Input to the MBR any appropriate postentitlement information by direct input where possible or forward it to the PC for processing.

NOTE: Disclose only the minimum information needed to complete the development per GN 03305.001C.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600901125
HI 00901.125 - Processing Undeliverable Health Insurance Cards and Enrollment Packages - 11/23/2001
Batch run: 05/15/2008
Rev:11/23/2001