When the NH reports WC/PDB payments have ended, obtain verification that the case
is closed and no further payments or awards are expected. For instructions regarding
obtaining verification, see DI 52145.001.
If the NH requests full benefits be paid until WC/PDB payment resumes or until proof
is received that no more payments will be made, take the following actions:
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Obtain the request in writing. It should include a statement acknowledging potential
overpayment and the repayment requirement.
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Obtain verification of the last date of payment.
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Verify that the NH did not receive a lump sum (LS) settlement.
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Post a special message to the MBR regarding the request and repayment statement. Indicate
in the message whether the repayment statement is in the Claims File User Interface
(CFUI).
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Route all WC/PDB documentation for permanent retention. For instructions regarding
retention, see DI 52145.001.
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After the necessary documentation is received, process the WC/PDB end date.
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In MCS, enter the end date on the WC/PDB Periodic Payments (WPPR) screen. For coding
information, see MSOM COMMON 001.005.
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If processing the end date as a post-entitlement event, enter payment information
on the WC/PDB Offset-Periodic Payments (WCPP) screen in ICF #32 or #34. For coding
information, see MSOM ICFT2 031.014.