Locate the beneficiary’s ROAR record on the bottom of the MBR. Review the beneficiary’s
appeal history and determine the PPV suspension or overpayment appeal date from the
chart.
ROAR
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Review Action
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BENEFIT line
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Find the current balance due for all overpayments for the beneficiary in BBAL-$$$$$
field.
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EVENT line
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Find the Event Identifier (EI) for the PPV overpayment (e.g., 01, 02) for the PPV
warrant in the administrative appeal fields.
Find the Type of Event (TOE) for the PPV overpayment on the EVENT data line, (e.g.,
T2 FF SUS/VIO, T2 FF SUS/FEL, OTHER, OR CONSOLIDATED LDO).
Find the STATUS of the current recovery effort for the PPV overpayment (e.g., BEN
ADJ, DUE PROCESS).
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HISTORY line
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Determine when ROAR received the PPV overpayment amount and the administrative appeal
in these fields. Check:
RUN DATE = FO established administrative appeal date (FO). TRANS = 23 AMOUNT = PPV
overpayment amount SRC = 3—DO DOCXXX WRI-W--WAIVER REQUEST, or WRI - R – RECON REQUEST,
or WRI – H –HEARING REQUEST
Example of a waiver request on ROAR:
RUN DATE FO established administrative appeal date (waiver request on the PPV overpayment).
TRANS = 23 AMOUNT =PPV overpayment amount SRC 3—DO DOCXXX WRI- WAIVER REQUEST
Then, followed by the personal conference date: (ROAR data same as the above example,
except for the following items.) WRI-P- PERSONAL CONF SOURCE-XXX WHLD-100.00 COM –
11/06 09/23/10 55 $3047.70 1-PSC SOURCE-001 CAT -- 67 --SPECIAL PAYMENTS DCAT-D1
NOTE: When evaluating Clark relief for an unfavorable PPV suspension or overpayment appeal
determination (e.g., waiver denial, reconsideration denial, etc.) the HISTORY RUN
DATE entry shows 10/19/2006 (HISTORY RUN DATE =10/19/06 plus five mailing days for
the initial determination notice = 10/24/2006) or later date to qualify for Clark
relief. For a pending administrative appeal, the HISTORY RUN DATE entries must show
that there is no final appeal determination 10/19/2006 (HISTORY RUN DATE =10/19/06
plus five mailing days for the initial determination notice = 10/24/2006) or later
for the relief qualifying T2 FF SUS/VIO overpayment.
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NOTE: A ROAR entry of INFORMAL WAIVER or PART W/H REQUEST means the person inquired about
waiver, but did not request a waiver, or the person requested overpayment recovery
through partial withholding. Neither ROAR entry qualifies as an administrative appeal.
If the WRI- WAIVER REQUEST is the last TC 23 pending ROAR appeal entry, give the beneficiary
Clark relief. For processing instructions, see GN 02615.130B in this section.
Examples of ROAR History:
Example 1
RUN DATE TRAN AMOUNT SRC
12/23/05 12 $6705.40
08/11/06 23 $6705.40 3--DO DOC-C51
WRI-N--INFORMAL WAIVER 09/14/06 43 $0.00 SOURCE-C51
WHLD-775.00 COM-10/06 SSC-2
10/19/06 23 $6705.40 3--DO DOC-C51
04/08/11 23 $20691.00 3--DO DOC-C80 WRI-
W--WAIVER REQUEST
06/22/11 43 $20691.00 SOURCE-C80 WHLD-1881.40 COM-06/11
09/23/11 23 $20691.00 1-PSC DOC-000 WRI-E—
EXPLANATION REQUEST
10/21/11 43 $0.00 WHLD-1948.90 COM-12/11 SSC-2
11/12/11 23 $20691.00 1-PSC DOC-000 RI-R--RECON REQUEST
The beneficiary is eligible for Clark relief because the last pending administrative
appeal request (i.e., reconsideration) on this case was 11/12/11.
Example 2
RUN DATE TRAN AMOUNT SRC
04/17/08 12 $36828.00
10/21/08 41 $0.00 WHLD-50.00 COM-10/08 SSC-T
10/30/08 84 $36828.00 1-PSC OLD1--PCMOD NEW2--PCDCU DOC-000
DY-PSC ALERT 12/03/08
11/04/08 23 $36828.00 3--DO DOC-600 WRI-P--PERSONAL CONF
11/21/08 84 $36828.00 1-PSC OLD2--PCDCU NEW1--PCMOD DOC-000
DY-PSC ALERT 02/02/09
02/12/09 42 $3173.20 WHLD-3173.20 COM-02/09
LST WH-02/09 SSC-B
05/04/09 22 $0.05 SSC-B
05/04/09 42 $1569.70 WHLD-1569.70 COM-05/09
LST WH-05/09 SSC-B
05/13/09 55 $36828.00 1-PSC SOURCE-600
CAT-97--OTHER DCAT-D1
06/25/09 43 $5800.00 WHLD-1450.00 COM-07/09
LST WH-10/09 SSC-2
11/12/09 23 $26285.05 3--DO DOC-600
WRI-R--RECON REQUEST
12/08/09 27 $26285.05 1-PSC
01/25/10 23 $26285.05 3--DO DOC-600
WRI-H--HEARING REQUEST
01/27/10 43 $4350.00 WHLD-1450.00 COM-02/10
09/27/10 43 $14682.55 WHLD-1450.00 COM-10/10
LST WH-08/11 SSC-T
The beneficiary is eligible for Clark relief because the last pending administrative
appeal request (i.e., hearing) on this case was 01/25/10.
Example 3
RUN DATE TRAN AMOUNT SRC
10/15/06 12 $9515.00
11/29/06 23 $9515.00 3--DO DOC-927
WRI-N--INFORMAL WAIVER
01/29/07 41 $250.00 SOURCE-927 WHLD-250.00 COM-03/07
LST WH-03/07 SSC-2
04/09/07 23 $9265.00 3--DO DOC-927
WRI-A--PART W/H REQUEST
04/10/07 41 $1350.00 SOURCE-927 WHLD-30.00 COM-05/07
LST WH-01/11 SSC-2
07/01/09 22 $584.00 SSC-T
The beneficiary did not administratively appeal. The beneficiary inquired about waiver
or had subsequent partial overpayment withholding. We made the final T2 FF SUS/VIO
determination on the initial PPV overpayment on 10/15/06. This beneficiary is not
eligible for Clark relief because the beneficiary did not file an administrative appeal
before 10/24/2006 and there was no appeal pending on or after 10/24/2006.
Review the ROAR HISTORY line for all administrative appeal periods. Determine the
beneficiary’s last level of PPV administrative appeal (i.e., waiver, reconsideration,
Administrative Law Judge (ALJ) hearing or Appeals Council (AC) review).
Next, determine the last administrative appeal request date.
Status of Administrative Appeal Decision
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Determination for Appeal Date
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closed (PC, ALJ or AC action on appeal) or
closed (FO determination on waiver) (no higher administrative appeal requested)
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Appeal date equals the determination date for the last highest level of PPV suspension
or overpayment appeal.
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pending (no PC, ALJ or AC action) or
pending (no final waiver decision) (no higher administrative appeal requested)
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Appeal date equals the date that the beneficiary filed their latest administrative
review request, but there is no final administrative review action.
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Process the beneficiary’s last administrative appeal request per the instructions
in this section for that particular appeal level:
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Denied Waiver or PC Reconsideration appeal cases
For instructions on processing denied waiver or reconsideration appeal cases, see
GN 02615.130B in this section.
NOTE: If the last administrative appeal is the ALJ level, obtain a current administrative
appeal query to learn the beneficiary’s appeals status. For information on reviewing
the administrative appeals query system, see GN 02615.130A.2.c. in this section.
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ALJ hearings
For instructions on processing ALJ cases, see GN 02615.130C in this section
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AC cases
For instructions on processing AC appeal cases, see GN 02615.130D in this section.