Examine the claims folder to see if the State buy-in is reflected on a Form SSA-1596-C1,
Record Changes in Premium Deductions or Billing Status, or on a manually processed
debit action (SSA-2795-U3 or SSA-2652-U2) and that the data shown is in agreement
with that alleged and that on the MBR. If so, prepare a final reply to the correspondent.
If the MBR data and allegation are not in agreement and the folder contains no evidence
of any State buy-in coverage, forward the correspondence to the appropriate DO for
development. Acknowledge the referral except when the correspondence originated from
the DO. Use a Form 41 (see examples below for the information to be given to the DO).
No control is necessary.
Annotate the Remarks portion of the Form 41 as follows:
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“Please review the attached correspondence and develop in accordance with HI 00815.088 and prepare any necessary reply because (insert (a) through (d) below or other explanation,
as appropriate):
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(a)
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folder contains no evidence of buy-in coverage
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(b)
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folder contains evidence of buy-in coverage for the months .
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(c)
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folder shows continuous buy-in coverage by the State of beginning.
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(d)
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Processing center has no record for this person under this claim number.”
To determine the DO to be contacted, see HI 01001.205. In most buy-in States, a specific DO has been established for handling buy-in issues.
If folder documentation is consistent with the allegation but inconsistent with the
MBR data, forward the case to the Benefit Authorizer for action to record the State
buy-in on the MBR and to prepare all required notices.