NOTE: The audience for this subchapter is the same: OS, OA, RP, FR, CR, SR, DRTM, TSC-MCR,
TSC-SR
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A.
Entitlement problems are those in which there is a question about one or more of the
following:
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1.
The fact or entitlement to HI or SMI benefits; or
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2.
The date of entitlement to HI or SMI benefits; or
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3.
The fact of termination of HI or SMI benefits; or
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4.
The date of termination of HI or SMI benefits.
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B.
The following procedures apply in the resolution of any entitlement problem, regardless
of how it is identified:
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2.
a carrier or intermediary reject (see HI 00920.001)
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3.
an individual questioning the entitlement information on an EOMB or disallowance notice.
These procedures may also be used for two other specific problems:
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5.
status of an End Stage Renal Dieases Claim.