Almost all miscellaneous issues on the Form CMS-2178 may be completely processed by
the Exceptions and Inquiries Examiner by following the instructions in this manual
and in SM 00613.000 ff. Basically, the principle behind PSC completion and routing
of the Form CMS-2178 remains the same as in all situations listed above.
If corrective action to the MBR and HIM is required, complete the “Reviewing Office Reply” portion of the CMS-2178 defining the data to be corrected. Send the blue original
to the DO and file the yellow copy on the right side of the folder.
If no corrective action can be accomplished due to lack of proofs or an inaccurate
allegation by the DO, explain the findings in the “Reviewing Office Reply” portion of the CMS-2178. Send the blue original to the DO and file the yellow copy
on the right side of the folder.
If a final determination on the issue cannot be made by the Exceptions and Inquiries
Examiner, prepare an interim reply to the DO and forward the folder to the appropriate
module specialist for a determination. Request that person to expedite his/her determination
and return the folder to the Exceptions and Inquiries Examiner after the determination
is made. Depending upon the determination, follow the above instructions for completing
and routing the Form CMS-2178.
In nearly all cited miscellaneous issues (items 2, 3, 4, and 8 of the Form CMS-2178),
the MISCOR program may be used to correctly update the MBR. The rules set down in
SM 00613.000 ff. should be used to effectuate each correction. The appropriate coding
sheet should be prepared by the Exceptions and Inquiries Examiner and forwarded to
the Data Entry operator per local instructions.
If full corrective action cannot be accomplished by using MISCOR, send the folder
to a Benefit Authorizer and request that all required corrective action be taken.
When the DO is requesting the status of an uninsured (T or M) claim refer to a Claims
Authorizer for handling.
A very general key to the specific MISCOR change coding sheet to be used to effectuate
changes requested via the CMS-2178 is shown below. Again, MISCOR can only be used
when full correction can be accomplished by using that program.
CMS-2178 Item |
MISCOR Coding Sheet |
2. (date of death) |
Form SSA-3621 (CIP D) |
3. (enrollee's name) |
For benefit data correction only, SSA-3621 (CIP D). For both benefit and payment or just payment data correction, give to a Claims Clerk.
|
4. (sex) |
Form SSA-2524 (CIP A) |
7. (cross-reference SSN) |
Form SSA-2525 (CIP H) |
8. (Dual-entitlement indicator) |
Form SSA-3621 (CIP D) |
8. (proof of date of birth indicator) |
Form SSA-3621 (CIP D) |
Instructions for completing Forms SSA-2524, 2525, and 3621 can be found in SM 00613.000
ff.