Retention Date: October 2, 2017
Retention Date: February 2, 2017
|Intended Audience:||All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/|
|Originating Office:||ORDP OISP|
|Title:||T2 Windfall: Releasing Retroactive Benefits when no SSI is involved-New Override Instructions|
|Type:||EM - Emergency Messages|
|Program:||Title II (RSI)|
|Link To Reference:||See References at the end of this EM.|
This emergency message (EM) provides instruction for processing Title II claims when no Supplemental Security Income (SSI) windfall offset is involved and technicians continue to receive the edit “SSI RECIPIENT: NO WINDFALL OFFSET ON BECF”. These instructions supersede GN 02610.055E2 and GN 02610.055E3, which we will update with new instructions at a future date.
Currently, when no windfall offset applies, field office (FO) and payment center (PC) technicians attempt to adjudicate the claim through MCS. However, many technicians continue to receive the edit “SSI RECIPIENT: NO WINDFALL OFFSET ON BECF” during adjudication. When the FO claims specialist (CS) receives the edit, the CS prepares an A101 for manual processing by the benefit authorizer (BA) in the PC. When the PC CS receives the edit, the CS codes a “6” on the BECF screen to bypass the MCS edit, adjudicates the claim through MCS, and requests the BA to release the withheld benefits immediately. We have created a new override option on the Management Override (MOVR) screen that will allow FO and PC technicians to process claims with no SSI windfall offset through MCS-EC, therefore, eliminating manual processing from the BA and releasing the Title II benefits at the time of adjudication.
NOTE: This is assuming that no additional processing exception/limitation exists.
C. New Procedures for technicians processing windfall offset when SSI does not apply
Effective May 2016, a new override option was added to the MOVR screen that will allow authorized staff to select option “5” on the MOVR screen to bypass the exception created by MCS EC due to the edit “SSI RECIPIENT; NO WINDFALL OFFSET ON BECF” screen.
1. FO and PC Claims Specialist (CS) instructions
Once the CS determines no windfall offset applies:
· Send the claim to the FO technical expert (TE) or PC technical expert (TE)/senior claims processing specialist (SCPS) to review the determination and perform the override.
· Once the CS receives confirmation that the override is complete, adjudicate the claim via MCS.
FO CR routes the request to the TE using normal procedures.
PC CS must send the TE/SCPS an email and send the ACR to the TE/SCPS review queue.
2. Claims Authorizer Technical Experts (TEs)/Generalist Claims Representative Technical Experts (TEs)/ Senior Claims Processing Specialist (SCPS) instructions
Upon receipt of a request for override:
NOTE: The MOVR screen override is inoperable if a “6” is present on the BECF screen.
Direct all program-related and technical questions to your regional Office (RO) support staff or Program Service center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns, or problems to their Central Office contacts.
GN 02610.055 Processing Administrative Law Judge (ALJ) Decisions in the Processing Center (PC) when Windfall Offset May be Involved
MS MCS 011.010 Management Override (MOVR) Section B
MS MCS 011.010, Management Override (MOVR) Section E
MS MCSEC 001.036, MCS EC Messages Section F
· Verify that SSI windfall offset is not involved;
· Access the MOVR screen via the MCS Main Menu, Option 1;
· From the MCS Systems Menu, select Option 27 “Management Override”; and
· On the MOVR screen, use Option 5 “No Windfall Offset Applies” to input the override.
EM-16026 - T2 Windfall: Releasing Retroactive Benefits when no SSI is involved-New Override Instructions - 08/02/2016