If there are any issues with the Buy-In, look over the following items to verify that they are correct on the case:

1. Certification period 12 months
2. Claim number on Bendex (Block B07)
   • Medicare cards are now issued with a new Medicare number that is unique to the beneficiary instead of using SSN-based Health Insurance Claim Number (HICN). The new Medicare cards will not affect the buy-in program and no case updates are needed. Buy-in will continue use the Social Security claim number (found on Bendex Block B07). If a client provides a new Medicare card, please scan it into the case file as we do now. The Medicare card will continue to verify Medicare eligibility and the demographic information needed for the buy-in program but Bendex can also be used for this verification as well. There is not a FACS block for the new Medicare number and only the social security claim is added to the case
3. QMB, SLMB or QI-1 coded on case
4. Spelling of name on case same as on Medicare card or Bendex
5. DOB on case same as on Bendex
   • If the answer is “no” to any of these, correct the case. A remedy ticket may still need to be submitted to correct the problem.
   • If the answer is “yes” to all of the above, submit a Remedy ticket.

1. Check Case
   • Certification Period = 12 FACS Medical General Tab or IMS D section block D7
   • Claim # number added on case (FACS income tab or IMS F section block F45) Claim # number can be found on Bendex (B07) unless it is Railroad retirement
   • DOB (FACS HH Tab or IMS F section block F15) and Name (FACS HH tab or IMS F section blocks F4, F5 and F6) match Medicare record (Name can be found on Medicare card and Bendex (B02, B03 and B04) and DOB (B09) can be found on Bendex)
2. Check Bendex
   • For Medicare (Blocks B40 (Part A), B45, B50 or B52 (Part B))
   • Premium Payer Codes (to see who is actually paying premiums) – B42 (Part A) and B47 (Part B) – S37 (Part A) and 370 (Part B) are Oklahoma payer codes
   • Premium Payer Start (B43 –Part A, B46 –Part B) and Stop (B44—Part A and B49– Part B) dates
   • For more information about Bendex, go to M Ben on IMS
3. Check BIL
   • TYPE (BI = accretion, RE = Response Record (normally posts with a rejection code, DE = Deletion, AC = Accretion Request)
   • AGENCY CODE (370 is Part B buy-in and S37 is Part A Buy-in)
   • TRAN CODE (1161/1163 accretion, 2161/2163 rejection,1751 deletion, 1728 another state paying buy-in, 1167 SSA posted buy-in, 1165 CMS posted buy-in, 15= No Medicare, 16=Death, 41= ongoing active Buy-in)
   • Top Line of BIL is the most current information
   • Railroad Retirement Buy-in will not show on PY – To see BIL you must manually type BIL RRR claim number on PY to pull it up.
   • For more information about BIL, go to M Ben on IMS

• If a customer already has Medicare, Part A and/or Part B and is QMBP eligible, we can pay the premiums for Part A (if any) and Part B. They do not have to go back to SSA to apply for the other part.
• Never give SSA Buy-in dates. If you have someone from SSA calling you for a date, please notify the State Buy-In Coordinator through Remedy Web.
• The day you are assigned an application, send a TPQYC if there are applicants that receive SSA benefits. Every time you get a CWA message saying you have a review due, send a TPQYC. Bendex can become old in 1 day.
• If a person has moved from another state where the buy-in was being paid, submit a Remedy ticket so buy-in can be sent for Oklahoma. Buy-in may not transfer automatically from state to state.
• Watch out for people with income in the SLMB range that do not have Part A. Veterans usually fall in this category. In order for us to pay the Part B premium under the SLMB program, the customer has to have Part A first.
• If a nursing home, ICF/MR, ADvantage, or DDSD waiver client is eligible as QMBP or SLMB, make sure he or she is coded for these benefits. Clients should receive all the benefits they are entitled to receive plus having this premium paid enables our clients to keep more income and makes more available to be deemed to ICF and ICF/MR community spouses. Also, with Medicare Part D it is imperative that dual eligible be identified.