HI 00930.001 Entitlement Problems
NOTE: The audience for this subchapter is the same: OS, OA, RP, FR, CR, SR, DRTM, TSC-MCR, TSC-SR
Entitlement problems are those in which there is a question about one or more of the following:
The fact or entitlement to HI or SMI benefits; or
The date of entitlement to HI or SMI benefits; or
The fact of termination of HI or SMI benefits; or
The date of termination of HI or SMI benefits.
The following procedures apply in the resolution of any entitlement problem, regardless of how it is identified:
health insurance card problem (see HI 00901.045)
a carrier or intermediary reject (see HI 00920.001)
an individual questioning the entitlement information on an EOMB or disallowance notice.
These procedures may also be used for two other specific problems:
status of a T or M claim
status of an End Stage Renal Dieases Claim.