Effective Dates: 09/29/2017 - Present Previous | Next

TN 4 (12-19)

GN 01050.075 Claims Routing Guide

This section provides information about determining Processing Center (PC) jurisdiction and routing of claims, including internet claims (iClaims). We organized the routing information in chart format by claim type (Non-Disability, Disability, and iClaims). Claims situations not covered by these instructions include cases involving:

  • •

    more than two PCs, or

  • •

    dual and triple entitlement.

Employees should use their best judgment to route claims not covered by these instructions, and document the decision on a report of contact (RC). If the PC receives a misrouted claim, the receiving PC adjudicates it and processes it completely.

Route a cross-referred Beneficiary Identification Code (BIC) “T” or “M” claim on Social Security Numbers (SSN) serviced by different PCs to its own PC, accompanied by an RC regarding the other claim.

A. PC Name/SSN Area Number Range/PC Claims Jurisdiction

Use this chart as a guide to determine PC jurisdiction of a claim. In most instances, determine PC jurisdiction by SSN area number (the first three digits of an SSN.) However, in some instances, determine PC jurisdiction by the type of claim as indicated in the column labelled ‘PC Claims Jurisdiction.’

In these cases, the claim type supersedes the SSN area number when determining PC jurisdiction:

PC Name

SSN Area Number Range

PC Claims Jurisdiction

PC1

Northeastern Program Service Center (NEPSC)

000-134, 729, 805-808

Environmental Health Hazards (EHH) Medicare claims

PC2

Mid-Atlantic Program Service Center (MATPSC

135-222, 232-236,

577-584, 596-599,

691-699, 809-826

 

 

PC3

Southeastern Program Service Center (SEPSC)

223-231, 237-267,

400-428, 587-595,

654-658, 667-675,

681-690, 730,

752-763, 766-804

 

 

PC4

Great Lakes Program Service Center (GLPSC)

268-302, 316-399,

700-728, 731

 

 

PC5

Western Program Service Center (WNPSC)

501-504, 516-524,

526-576, 586,

600-626, 646-647,

650-653, 680,

733-751, 764-765,

827-867

 

PC6

Mid-America Program Service Center (MAMPSC)

303-315, 429-500,

505-515, 525, 585,

627-645, 648-649,

659-665, 676-679,

732, 868-899

 

PC7

Office of Disability Operations (ODO)

N/A

DIB claims (age less than 54), and End Stage Renal Disease (ESRD) Medicare claims.

PC8

Office of Earnings and International Operations (OEIO)

N/A

Foreign Claims

B. Non-disability claims routing

Use this chart as a guide to determine where to route all non-disability claims:

Situations

Routing

Remarks

1. INITIAL CLAIMS

(No Prior Claim Filed)

PC with jurisdiction of the SSN area number.

EXCEPTIONS:

Foreign involvement (see GN 01050.075B.3. in this chart);

Cross-Reference multiple folder involvement (see GN 01050.075B.5. in this chart); and

Disability involvement (see GN 01050.075C in this section).

2. SUBSEQUENT CLAIMS

PC with jurisdiction of the SSN area number.

EXCEPTIONS: Disability involvement (see GN 01050.075C. in this section);

Foreign involvement (see GN 01050.075B.3. in this chart);

Survivor involvement see GN 01050.075B.8.a. and GN 01050.075B.8.b. in this chart.

3. FOREIGN INVOLVEMENT

OEIO

Applicable:

if any claimant resides outside of the *U.S.; or

if any claimant uses a mailing address outside the *U.S.; or

if any claimant has been, or will be, outside the *U.S. for more than 6 months.

*“U.S.” includes all 50 States, the District of Columbia, American Samoa, Guam, Puerto Rico, the Northern Mariana Islands (NMI), and the U.S. Virgin Islands.

4. TOTALIZATION CLAIMS

​

See Routing of Claims for U.S. Benefits Involving Totalization in GN 01702.310; and

Routing of Claims for U.S. Totalization Disability Benefits in GN 01702.410.

5. MULTIPLE FOLDERS (Multiple Claims)

X-Reference with STAT code “R”, “P”, or BIC

 ​

If there is disability involvement, see GN 01050.075C in this section.

    a. Initial Claims on each SSN  

Route each claim to the PC with jurisdiction of the SSN area number (with the exception of disability and foreign.)

​

    b. Initial Claim for one NH; subsequent claim under another NH’s SSN

Route each claim to the PC with jurisdiction of the SSN area number (with the exception of disability and foreign.)

​

    c. Retirement Insurance Benefits (RIB) entitlement only

PC with jurisdiction of the SSN area number, or of each SSN area number (when there is more than one).

​

6. All other claim types not mentioned in other sections

PC with jurisdiction of the SSN area number.

EXCEPTIONS:

Foreign involvement (see GN 01050.075B.3. in this chart);

Cross-Reference multiple folder involvement (see GN 01050.075B.5. in this chart); and

Disability involvement (see GN 01050.075C in this section).

7. Lump-sum only claims

PC with jurisdiction of the SSN area number.

 ​

8. Subsequent claims; except

PC with jurisdiction of the SSN area number.

 ​

    a. Survivor claim filed when disabled primary claimant (HA) dies

PC other than ODO with jurisdiction of the decedent’s SSN area number.

 ​

    b. Sole survivor claim filed by RIB beneficiary

PC with jurisdiction of decedent’s SSN area number.

 ​

C. Disability claims routing

Use this chart as a guide to determine where to route all disability claims. Route claims with disability involvement to the Disability Determination Services (DDS), ODO, or if “foreign,” OEIO, per instructions in the chart. For age 54 Disability Insurance Benefits (DIB) claims, refer to DI 11010.280. When returning a claim once a determination has been made by the DDS, the "jurisdictional FO or WSU" is the component that sent the claim to the DDS for a decision. For jurisdiction and routing instructions when a claimant moves during the disability process, see DI 20101.035 and DI 81020.125.

Situations

Pre-Adjudicative Routing

Adjudication

Post-Adjudicative Routing

DDS Jurisdiction for Disability Determination

to DDS per DI 11010.255

 

 

Allowance

Jurisdictional FO or WSU based on terminal digits of NH's SSN

Jurisdictional FO or WSU based on terminal digits of NH"s SSN (except adverse claim or appeal pending at ODO).

to ODO

Denial

Jurisdictional FO or WSU based on terminal digits of NH's SSN

Jurisdictional FO or WSU based on terminal digits of NH's SSN

Retain in FO per DI 11010.370.

SSA Jurisdiction for Disability Determination

to ODO per

DI 11010.255.

ODO

 

Technical Denials

 

Jurisdictional FO or WSU based on terminal digits of NH's SSN

Retain in FO per DI 11010.370.

Other Claims; No Disability Determination

 

FO (except adverse claim or appeal pending in ODO)

to ODO per

DI 11010.340.

Foreign Address

to OEIO

OEIO

to OEIO.

Career Railroad

to GLPSC

GLPSC

to GLPSC.

DIB-RSI claim

See DI 11010.300

 

 

DIB auxiliary claim

 

 

PC which has the Wage Earner’s (WE’s) disability file (ODO, PC, or OEIO).

NOTE: If technical entitlement is established on one SSN, but payment will be made on another SSN, see GN 01050.060E.

D. Internet claims (iClaim) routing

Use this chart as a guide to determine where to route all iClaims:

Situations

Pre-Adjudicative Routing

Adjudication

Post-Adjudicative Routing

 

 ​ ​ ​

iClaims with domestic residence address.

Jurisdictional FO or WSU based on terminal digits of NH’s SSN.

 

 

 

 

Jurisdictional FO or WSU based on terminal digits of NH’s SSN.

PC with jurisdiction of the SSN area number.

iClaims with foreign residence address including APO, FPO, and DPO addresses.

OEIO

EXCEPTION: All Canadian iClaims will route to the servicing FO based on the first three characters of the postal code. Canadian iClaims with no postal code will route to OEIO.

 

OEIO

OEIO
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201050075
GN 01050.075 - Claims Routing Guide - 09/29/2017
Batch run: 12/04/2019
Rev:09/29/2017