Identification Number:
GN 02602 TN 77
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Continuing Eligibility
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 026 – Posteligibility
Subchapter 02 – Continuing Eligibility
Transmittal No. 77, 02/09/2021

Audience

PSC: BA, CA, CCRE, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BIES, BTE, CR, CTE, FCR, FDE, PETL, RECONR;
OCO-ODO: BTE, CCE, CR, CST, CTE, CTE TE, DSE, PETE, PETL, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, CTE, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

The Office of the Inspector General (OIG) performed an audit of Old-Age, Survivors and Disability Insurance (OASDI) post-entitlement alerts that required manual action. As a result of the audit, OIG recommended that we update our policy to require Processing Center (PC) employees to document their reasons for clearing alerts without taking corrective actions. Therefore, we are revising GN 02602.005 to satisfy this recommendation and to improve our controls over actions taken by Field Office (FO) and PC employees as a result of a change in a beneficiary's circumstances.

 

Summary of Changes

GN 02602.005 Post-Entitlement Changes that Affect Payment of Title II Benefits

We changed the title of this section from "Factors that Affect Eligibility to Title II Benefits" to more accurately reflect its content. We also divided this POMS section into subsections to provide more detailed policy and new procedures for processing post-entitlement (PE) actions.

GN 02602.005A: This new subsection includes the original content of GN 02602.005, more detailed information on how a change in a beneficiary's circumstances may affect his or her benefits, and new policy requiring Processing Center (PC) technicians to document their reasons for clearing alerts without taking corrective action.

GN 02602.005B: This new subsection identifies some of the methods through which we may receive a report about a change in a beneficiary's circumstances.

GN 02602.005C: This new subsection provides brief descriptions of Title II Redesign (T2R) and Regular Transcript Attainment and Section Pass (RETAP) alerts.

GN 02602.005D: This new subsection provides new procedures for processing PE actions in FOs and PCs.

GN 02602.005E: This new subsection provides new procedures for the documentation and disposition of PE actions.

GN 02602.005F: This new subsection provides references.

GN 02602.005 Post-Entitlement Changes that Affect Payment of Title II Benefits

 

A. Policy

Once a beneficiary becomes entitled to Title II benefits, we must update the beneficiary's record to reflect changes in the beneficiary's circumstances. This will ensure we continue issuing the correct benefit payment. Changes in the beneficiary's circumstances may result in suspension, deduction, nonpayment, adjustment, or termination of benefits. Changes in benefit delivery may also require updates to the beneficiary's record. We refer to these updates as post-entitlement (PE) actions.

Title II systems automatically process many PE actions. If these systems cannot automatically process an update, manual action is required. When an update requires manual processing, the PE processing system produces an exception or a processing limitation. A Title II input could also result in an alert, meaning the input action was processed but the record requires additional review. A Processing Center (PC) technician must review the alert, exception, or processing limitation, correct any issues that prevented the system from automatically processing the update, and make the necessary changes to the beneficiary's record. PC technicians must also document their reasons for clearing exceptions, processing limitations, or alerts without taking corrective actions.

IMPORTANT: Changes to a number holder's (NH) record may also affect the payment of benefits to auxiliaries or survivors receiving benefits on the NH's record.

For SSI cases, see SI 02300.000 Post Eligibility Events.

1. Suspension, deduction, and nonpayment of benefits

Suspension, deduction, and nonpayment provisions of the law affect a beneficiary's eligibility to receive benefits for a given period. Examples include prisoner suspensions, work deductions, no child-in-care deductions, Workers' Compensation/Public Disability Benefit offset, and applicability of the Windfall Elimination Provision (WEP) or Government Pension Offset (GPO).

2. Adjustment of benefit amount

Some changes may result in an adjustment of the beneficiary's benefit amount. Examples include new entitlement on another record, termination of benefits for another auxiliary on the record, or credit for additional earnings.

3. Termination of entitlement to benefits

Entitlement to monthly Title II benefits continues until a terminating event occurs. Examples of terminating events include death of the beneficiary, marriage, divorce, and attainment of age 18 for a child beneficiary who is not disabled or a full-time student.

A terminating event ends a beneficiary's entitlement to benefits until we establish a new period of entitlement.

4. Change in benefit delivery

Prompt delivery of benefits depends on accurate Social Security records. To ensure records remain up-to-date and accurate, technicians must evaluate and process changes in address, direct deposit, or representative payee needs in a timely manner.

B. Sources of information about changes in a beneficiary's circumstances

We may receive a report about a change in a beneficiary's circumstances through a variety of methods, such as:

  • Direct contact with the beneficiary or representative payee,

  • Third-party reports,

  • Data exchanges,

  • System diaries,

  • Requests for assistance from the Field Office (FO), PC, or other component,

  • Paperless submissions,

  • WorkTrack files,

  • Modernized Development Worksheet (MDW) referrals,

  • Recovery of Overpayments, Accounting and Reporting (ROAR) alerts,

  • Prisoner Update Processing System (PUPS) alerts,

  • Audit workloads,

  • Electronic Request for Assistance/Certification of Documents or Records (e562),

  • Ad hoc workloads, and

  • Garnishment and other enforcement alerts.

Each report of change may require manual action or generate an alert to the PC.

C. Changes that require manual action by PC

Changes that require manual action will alert to the PC. These alerts may include:

1. Title II Redesign (T2R) Alerts

T2R automatically processes many PE actions to update the Master Beneficiary Record (MBR) (see SM 03001.000). In some circumstances, T2R cannot fully process all necessary updates. When this happens, T2R sends an exception or processing limitation to the Processing Center Action Control System (PCACS), and a PC employee must manually update the beneficiary's record via MACADE. T2R also produces alerts, where the input action has processed, but the record may need additional actions.

2. Regular Transcript Attainment and Selection Pass (RETAP) Alerts

The RETAP program identifies MBRs that require action in a given month (see SM 03020.001). RETAP also produces alerts to the PCs to notify them of necessary actions. For descriptions of RETAP alerts, see SM 00619.050.

D. Processing PE Actions

Follow these instructions when processing a PE action:

1. Review MBR

Since the release of T2R, the MBR must be free of any inconsistencies in order for automated actions, as well as most manual actions, to update to the record. During case processing, technicians must review the entire MBR and examine all pending actions.

Some things to consider when reviewing the MBR include:

  • Ledger Account File (LAF) status,

  • Special messages,

  • Suspension codes,

  • MBR data lines,

  • Dual entitlement, and

  • Accuracy of the Primary Insurance Amounts (PIA) and Month Benefit Amounts (MBA).

Additional factors may be involved, such as:

  • Critical Payment System (CPS) payments,

  • PCACS diaries,

  • MDWs,

  • Medicare,

  • Workers' Compensation,

  • Attorney fees/Appointed Representative fees,

  • Garnishment,

  • SSI offset,

  • Levy for unpaid federal taxes,

  • WEP,

  • GPO,

  • Overpayments, and

  • Underpayments.

2. Processing PE actions in the FO

The Post Entitlement Online System (POS) is the most common method for FO technicians to input Title II PE actions, but there are other systems the FO may use to take action on a reported change, such as the:

  • Miscellaneous Online Edited Transactions (MONET) system,

  • Income Related Monthly Adjustment Amount (IRMAA) data collection screens,

  • Change in Primary Insurance Amount (CIP) application,

  • Interactive Computation Facility (ICF), or

  • Debt Management System (DMS).

When processing PE actions in the FO, take the following steps:

  • Review the documentation provided by the beneficiary or third party;

  • Review the entire MBR (see GN 02602.005D.1);

  • Check for any other pending inputs or WorkTrack files and Paperless Read Only Query System (ROQS);

  • Complete all necessary development;

  • Make the necessary input to update the beneficiary's record (POS, CIP, EF101, ICF, DMS, etc.);

  • Include remarks to explain the action taken;

  • Retain any documentation per GN 00301.286 Electronic Evidence Documentation and Retention; and

  • Follow instructions in GN 02602.005E for disposition and documentation.

NOTE: If the POS action excepted in the PC, do not re-input the action unless you can determine the reason why it excepted and correct your input. Simply re-inputting the action creates multiple exceptions in the PC. You can review the ROQS and Transaction History Query (THIS) to determine if your input excepted (see MS 02901.002 and MSOM 05203.012).

To request PC assistance and to follow-up on your request, refer to GN 01070.425 for modes of responding to request for assistance and GN 01070.440 for follow-up timeframes.

3. Processing PE actions in the PC

Pending PE actions are controlled in the PC by an Action Control Record (ACR). PC technicians input Title II PE actions using a variety of systems, such as:

  • Manual Adjustment, Credit and Award Data Entry (MACADE),

  • CIP,

  • POS,

  • MONET,

  • ICF, or

  • DMS.

When processing PE actions in the PC, take the following steps:

  • Review the source document (which may include the diary, alert, fax, etc.);

  • Check for any other pending actions (be alert to ACRs pending in other PCs);

  • Review the entire MBR (see GN 02602.005D.1);

  • Review the completed side of Paperless for reference purposes;

  • Complete all necessary development (keep the ACR active during development);

  • Make the necessary updates to the beneficiary's record (be sure to address the issue that resulted in the T2 exception or processing limitation as well as the input action);

  • Document the disposition of the ACR (see GN 02602.005E); and

  • Clear the ACR. Be sure to change the ACR retention to long-term as needed per GN 01085.000.

If you receive an exception or processing limitation, you must address the reason that caused the exception or processing limitation as well as the input action that did not process. Each technician who takes action in a case must document the action and disposition of the ACR. "Action" and "disposition" include sending the ACR to an end-of-line read (FIN/FIN) without systems input (see GN 02602.005E).

NOTE: When processing an action you must process all the ACRs that are pending for your job type, i.e. Benefit Authorizer (BA), Claims Authorizer (CA), Check Claims and Recovery Examiner (CCRE), etc. To do this you must always "GET FOLDER." In addition, you must look at all the ACRs with a different job type to see how they may affect your action. When a case has multiple ACRs pending, work the oldest ACR and send any younger, subsequent alerts/ACRs to FIN if it can be determined that they are duplicates. Prior to sending any duplicate ACRs to FIN, document the ACR according to GN 02602.005E.2. Remember that after taking your action you need to route all the ACRs you processed from the "GET FOLDER" view.

E. Disposition Requirements

Unless another POMS section specifies the documentation and disposition requirements for your PE action, post remarks to support your action within the PE method used to update the record, e.g., PCACS remarks, DMS remarks, etc. This action documents any determinations made and may prevent another technician from having to re-work the case.

1. FO requirements

The FO technician must document his or her action on the case. The documentation must include:

  • A remark to support the action taken or reason for not taking an action,

  • The technician's identifier (unit code, name, or initials), and

  • The date.

NOTE: Some PE systems, such as POS, automatically add the technician's name and the date.

2. PC requirements

Most PE actions in the PC are accompanied by an ACR in Paperless. Each technician who takes action in a case must document the action and disposition of the ACR. "Action" and "disposition" include sending the ACR to an end-of-line read (FIN/FIN) without systems input. The Paperless disposition of the technician's action must include:

  • A brief description of the action taken (for example: "Notice released," "MACADE with 1 letter," or "Action controlled by ACR SSNX____," etc.);

  • The technician's identifier (name or initials); and

  • The date.

NOTE: Paperless e-forms electronically add the technician's name and date.

When the disposition is "No Action Necessary" (NAN), include an explanation of why there was no action necessary by attaching a Claims Folder/Material Transmittal (Form SSA-559) within Paperless ACR.

If the technician's action will clear multiple ACRs, the technician must post a disposition on all ACRs, including:

  • The controlling one, i.e., the one going to the Payment Holding File (PHF) in MACADE;

  • The non-controlling ACR(s), i.e. the one(s) going directly to FIN, indicating "ACR worked in conjunction with SSNX_____"; and

  • Any duplicate ACRs. Send duplicate ACRs to FIN with a comment "Duplicate ACR/Action being controlled by ACR SSNX_____."

IMPORTANT: Only send duplicate ACRs to FIN when taking action on the controlling one.

F. References

GN 00301.286 Electronic Evidence Documentation and Retention

GN 00301.316 The Purpose of the Non Disability Repository

GN 01070.425 Modes Of Responding To Request For Assistance

GN 01070.440 Follow-Up Timeframes

GN 01085.000 Retention Periods for Program-Related Documents and Forms

SI 02300.000 Post Eligibility Events

SM 00619.050 Regular Transcript Attainment and Selection Pass Alerts (RETAP)

SM 03000.000 TII Redesign System Processing

SM 03001.000 TII Redesign System Processing

SM 03020.001 Entitlement and Eligibility Processing - Overview


GN 02602 TN 77 - Continuing Eligibility - 2/09/2021