Purpose: Ensure eligible clients receive the correct Medicare premium assistance by reducing the number of CMS buy-in rejections and need for Remedy Tickets that our State Buy-in Coordinator need to correct daily. PLEASE SEE THE FOLLOWING TIPS:
- Confirm Medicare Eligibility
- Verify Medicare entitlement or enrollment before adding Buy-In.
- Receiving SSI or RSDI does not automatically establish Medicare eligibility.
- Check age and other qualifying requirements.
- Add Buy-In only for eligible clients and ensure the D section is coded with a 12-month period.
- Verify Client Information/Medicare Claim Number
- Match the client’s name exactly to BENDEX. In the household name block in FACS, check to make sure extra characters, such as CM, PY or ED, are not added to the client’s name. If so, correct the name if entered by mistake before saving the case in FACS.
- Verify Medicare Claim Number, SSN and DOB using BENDEX and/or SDX only. If the verified SSN or DOB does not match BENDEX, submit a Remedy ticket after Buy-In certification.
- Do not enter only the SSN when the full claim number is required. Enter the complete claim number, including the letter alphabet.
- Review Block B47 — Out-of-State Buy-In
- Investigate before certification by reviewing BENDEX for the correct address. An Oklahoma address does not mean the previous state’s Buy-In is closed.
- Oklahoma’s state code is 370. If B47 shows another state (refer to the BENDEX State Codes | Quest)
- Have the client contact the previous state to request Buy-In closure, as applicable. Complete an Out-of-State Inquiry when required.
- Follow required procedures before certification.
- Select the Correct Effective Month
- QMB: Verify the effective month. When applicable under program rules, if the case is not already open and no SSP is being certified, the “Q” benefit can begin with the month after eligibility is determined. The “M” medical benefit can be added for three months of retroactive coverage if all other factors of eligibility are met. *Note: If certifying SSP and QMB, the “Q” benefit can start the same month as the SSP.
- SLMB/QI-1: Review eligibility for up to three months of retroactive coverage and add eligible months.
- Do not automatically use the certification month. Follow applicable program rules.
Final Checklist Before Certifying Medicare Buy-In
| ☐ | Medicare eligibility confirmed. |
| ☐ | Name, SSN, and DOB verified; complete Medicare claim number entered. |
| ☐ | Block B47 reviewed; out-of-state issues addressed when required, including submission of an out-of-state inquiry request. |
| ☐ | Correct effective month selected and shown in the D section certification block as 12 months; retroactive eligibility reviewed. |
Remember: Incorrect information, claim numbers, state Buy-In status, or effective months can prevent Buy-In from crossing over correctly and denying premium coverage for clients. Verify, investigate discrepancies, and follow program rules before certification.
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