TN 54 (02-23)

HI 01001.310 Billing for Premiums after an Incorrect Termination

In some cases, although premiums were paid timely they may not be recorded timely and the enrollee may be notified erroneously that their Supplementary Medical Insurance (SMI) coverage has been terminated (e.g., premiums were paid just before the end of the grace period, etc.). In most cases, the error will be detected promptly, entitlement reinstated, and they will subsequently receive a premium billing notice.

However, in some cases, the error may not be caught and corrected in time (e.g., the enrollee's premium payment was credited to some other person). In these cases, a premium payment adjustment will be made to their record, the enrollee's entitlement will be reinstated and they will be billed for all premiums due in accordance with HI 01001.085.

Where the enrollee visits the field office (FO) protesting an incorrect premium bill or termination of their entitlement on the ground that they paid their premium timely, ask only for the evidence of payment (canceled check or a copy of the front and back of the check). If the enrollee does not have a copy of the canceled check, obtain a statement concerning the time and manner of payment.

Where evidence (canceled check) is presented at the FO, the FO representative should review the on-line direct billing record to determine if the payment was applied after the bill was sent. If the payment is shown, inform the enrollee that the payment was received and processed. If the payment is not shown, forward a copy of the canceled check (back and front) to Centers for Medicare & Medicaid Services, Center for Beneficiary Choices, Division of Information and Assistance, 7500 Security Boulevard, S1-20-21, Baltimore, MD 21244-1850.