1. Title II MCS exclusion
The technician does not need to establish a new claim in MCS for the following Title
II conversion claims:
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Auxiliary child benefits (AUXCHD) to Childhood Disability Benefits (CDB) for continuing
eligibility. For further instructions, see RS 00203.080.
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Mother's or Father's benefits to Disabled Widow(er)’s Benefits (DWB). For further
instructions, see DI 11015.005C.
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WIB or Mother's or Father's benefits to DWB for Medicare purposes. For further instructions,
see RS 00207.020.
Using the MCS Exclusion functionality, you can establish the following claims in EDCS,
as long as the claimant is on an existing Master Beneficiary Record (MBR) with a specific
Ledger Account File (LAF) code:
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CDB and DWB under age 60 - LAF
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NOTE: The technician must establish appeal level cases in EDCS using the MCS exclusion
functionality for CDB or DWB claims if the MCS exclusion functionality was used for
the associated prior level case.
2. Title XVI MSSICS/CCE exclusion
a. Technicians can manually establish an initial level Title XVI MSSICS/CCE exclusion
or MSSICS/CCE limitation claim in EDCS.
b. EDCS also allows you to establish Manual Title XVI appeal level cases even if there
is no prior Title XVI medical determination in the electronic folder. EDCS allows
the technician to switch the adjudicative level from appeal to escalated initial on
Manual Title XVI appeal level cases.
c. Technicians should manually establish a MSSICS/CCE exclusion claim in EDCS for
aged individuals, 65 years and older, requiring a medical determination to qualify
for the pooled trust exception. See SI 01120.203D for more information on pooled trust exceptions.
IMPORTANT: Do not use the Manual Title XVI functionality to establish CDR initial or CDR appeal
cases. A Title XVI Age 18 redetermination is a CDR. Do not process these cases using
the Manual Title XVI functionality in EDCS. For further processing instructions, see
DI 81010.232.
Examples of possible MSSICS/CCE exclusions or limitations:
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SSI Couples Case Processing Limitations
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Child filing and parent has no SSN
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Terminated Supplemental Security Record (SSR)
NOTE: For concurrent claims where the Title XVI portion is an allowance, but Title II portion
is a denial, EDCS blocks creation of the Title XVI portion of any appeal because it
was an allowance. If the claimant files a request for an Administrative Law Judge
(ALJ) hearing, in order to establish the Title XVI portion (allowance) of the case
in EDCS for this situation, please use the Manual Title XVI case creation process
described below in this section. Per DI
12010.001.B5, if a claimant appeals any medical issue for any disability claim, the entire claim
is subject to review, including any prior favorable disability determination. Therefore,
create a concurrent hearing for ALJ review.
d. To create a Manual Title XVI claim in EDCS:
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On the Case Creation screen, select "yes" to the question, "Does this case have a
T16 claim that cannot be brought into EDCS electronically and must be manually created?,"
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Select the reason for manually creating the case from the drop down list. If you select
"Other," you must provide a reason,
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Add the protective filing date,
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On the Manually Created T16 Information screen, provide the alien admission date (if
applicable),
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Presumptive disability onset date (if applicable), and
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T16 Claims Representative unit code.
When you establish the case in EDCS, fax the paper Title XVI application and any other
paper documents associated with the claim into the electronic folder.