TN 25 (10-16)

NL 00730.010 Title II Redesign (T2R) Notices Not Generated

The T2R notice process does not generate a notice for every T2R update. This section explains when T2R does not generate a notice.

T2R does not generate a notice when one or more of these events occur:

A. Based on maturity

  • When automatic Medicare enrollments based on an Initial Enrollment Period (IEP) are annotated to the Master Beneficiary Record (MBR) prior to maturity, the Centers for Medicare and Medicaid Services (CMS) sends an Initial Enrollment Period (IEP) package to the beneficiary. T2R sends a notice when the Hospital Insurance (HI)/Supplemental Medical Insurance (SMI) actions mature

  • When there are withdrawals with a future effective date. Notices are sent when the actions mature.

  • When there are terminations for HI/SMI with a diary date. Notices are sent when the actions mature.

  • If the pre-MBR ledger account field (LAF) is in the status of active Title XVIII only (U), the post-MBR LAF shows health insurance benefits (HIB)/SMIB is terminated (X7) and there are no changes in the last occurrence of HI or SMI data when comparing the pre- and post-MBRs. T2R does not build a notice for MBR LAF U or X7 situations because it advises the beneficiary of the HI/SMI termination dates when we place the beneficiary in LAF U. The Enroll Process changes the LAF to X7 because the HI/SMI termination dates matured.

  • If advance filing actions or deferred status actions mature to current pay with no SMI or voluntary tax withholding (VTW) deduction from the beneficiary’s check and no payment cycle indicator (PCI) changes. This action does not require a notice because T2R sends a letter when we award the benefits and we place the beneficiary in advance file status or deferred status. When the advance filing or deferred to current pay actions mature, there is nothing to tell the beneficiary about the maturity; however, T2R may generate a notice for other MBR changes.

B. Duplication of information

  • If the premium-HI penalty rate reduces to the basic premium HI amount. This action does not require a notice because the Centers for Medicare and Medicaid Services (CMS) advises the uninsured Beneficiary Identification Code (BIC) who is not qualified for automatic health insurance benefits (M) in the CMS premium billing notice of the change in the HI premium amount.

  • If the General Enrollment Period (GEP) enrollment annotated to the MBR for a beneficiary is in an LAF status of current pay, suspension, or deferral (C, S, or D) and the SMI start date is greater than current operating month (COM), plus one month. T2R will send a notice when SMI premium deduction starts.

  • When the Medicare Advantage organization code changes and there is no change in the Medicare Advantage reduction amount. This action does not require a notice because the beneficiaries receive a letter from their new Medicare Advantage Plan when they enroll.

C. No rate change

  • When there is a conversion of Medicare entitlement based on age and the SMI premium is the SMI base rate. This action does not require a notice because the SMI premium rate is not changing.

  • When users input a change in the third-party state code for open third-party coverage, and the state coverage is continuous, CMS does not require us to advise the beneficiary of the change in state code.

  • When there is an MBR annotation-only action (via MONET). Annotation-only actions do not require a notice although T2R may generate a notice based on other updated MBR changes.

D. T2R notices that stopped generating in June 2004

  • When the post-MBR LAF status is in current pay through the Railroad Board (LAF E) or the historical reason for suspension or termination (HRFST) is Railroad Board (RAILRD), no notice is required per Office of Program Benefits (OPB) policy; when the Railroad Board (RRB) receives the interface record from us, the RRB will advise the beneficiary accordingly.

  • When the post-MBR LAF status is a delayed claim, a claim terminated from delayed status, a technical disallowance, or a medical denial (PB, PT, N or ND). T2R never sends a notice to a beneficiary in a delayed or denied status.

E. T2R notices that stopped generating in November 2005

When all of the following exist:

  • Pre-MBR LAF = Terminated (T) with any subscript (e.g., T1, T3, etc.),

  • Post-MBR LAF = T (with any subscript),

  • Pre-MBR Historical Date of Entitlement Termination (BCLM-DOETERM) equals the post-MBR BCLM-DOETERM-REL date, and

  • The system made updates to the deductions additions history (DAH) data on the post-MBR.

  • There is no Prior Month Accrual being paid.

  • There is no new overpayment accrual or the new overpayment accrual amount is less than or equal to the total overpayment(s) of other beneficiaries on the record.

The T2R Summary process will update occurrences of DAH data showing net amount due = $0.00 and the current Monthly Benefit (MBC) = $0.00 for a terminated beneficiary. The T2R notice process recognizes that a notice is not required for this situation.

F. T2R notices that stopped generating in November 2006

  • When the Rep Payee System (RPS) sends T2R an annotation only for an RPS change (this includes dual entitlement processing for the non-input dual entitlement (D/E) record).

  • When Income-Related Monthly Adjustment Amount (IRMAA) data updates annually to the MBR prior to the Benefit Rate Increase (BRI) Operation, we do not need to send a notice because the new SMI rate is not effective until Current Operating Month (COM) 12 when BRI runs.

G. T2R notices that stopped generating in May 2008

  • For the non-input D/E record, if the pre-MBR LAF status is adjusted for dual entitlement (AD) or LAF S (with any subscript) and the post-MBR LAF = AD or LAF S (any) and both the prior month accrual amount (PAMT) and current amount (CAMT) equals zero ($0.00). In addition, if present, there is no change in the special payment amount (SPA), beneficiary over/underpayment data (BOUD) or overpayment recovery amount (OPRA) values.

  • When the pre-MBR HRFST is not a disabled beneficiary in suspense status due to the provisions of the four-state $2.00 for $1.00 demo project (DMPRD3). In addition, the post-MBR HRFST equals DMPRD3 for any effective date.

NOTE: Since the T2R system can process multiple events at the same time, not generating a notice for one event does not prevent a notice from generating for another event. For example, an MONET action does not generate a notice and an SMI maturity generates a notice.

H. T2R notices that stopped generating in September 2012

When the only updates to the MBR is annotation only data along with the removal of a Mid-Year Mailer Indicator.

I. T2R notices that stopped generating in December 2012

In dual entitlement cases where an overpayment transfer involves a spouse on a non-pay (LAF AD) record to the spouse’s own pay (LAF C) record, T2R does not generate a notice for the LAF AD’s record based on data received on the Trigger Record.

In this case, the manual notice process issues an incomplete notice for the LAF C record with an incomplete code of 035. The Trigger Record indicates the BICs for the LAF C’s incomplete notices.

J. T2R notices that stopped generating in September 2015

The Regular Transcript Attainment and Selection Process (RETAP) selects and terminates beneficiaries who are at least 115 years old who have been in suspense for at least 7 consecutive years. T2R does not generate a notice for beneficiaries in LAF T9 with HRFST of AGETRM.


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http://policy.ssa.gov/poms.nsf/lnx/0900730010
NL 00730.010 - Title II Redesign (T2R) Notices Not Generated - 10/13/2016
Batch run: 10/13/2016
Rev:10/13/2016