HI 00930.001 Entitlement Problems

NOTE: The audience for this subchapter is the same: OS, OA, RP, FR, CR, SR, DRTM, TSC-MCR, TSC-SR

1. A. 

   Entitlement problems are those in which there is a question about one or more of the following:

   1. 1. 

      The fact or entitlement to HI or SMI benefits; or

   2. 2. 

      The date of entitlement to HI or SMI benefits; or

   3. 3. 

      The fact of termination of HI or SMI benefits; or

   4. 4. 

      The date of termination of HI or SMI benefits.

2. B. 

   The following procedures apply in the resolution of any entitlement problem, regardless of how it is identified:

   1. 1. 

      health insurance card problem (see HI 00901.045)

   2. 2. 

      a carrier or intermediary reject (see HI 00920.001)

   3. 3. 

      an individual questioning the entitlement information on an EOMB or disallowance notice.

   These procedures may also be used for two other specific problems:

   1. 4. 

      status of a T or M claim

   2. 5. 

      status of an End Stage Renal Dieases Claim.