Topic: buy-in
The coding to certify a case in FACS for SLMB
QI-1 can be certified effective three months prior to the month of application, if all factors of eligibility were met all three months. For additional information regarding factors of eligibility for QI-1, refer to article ABD: Qualified Individuals – Group 1 (QI-1). If all factors of eligibility were NOT met prior to month of application, […]
Certifying the medical and buy-in benefits under QMBP eligibility
What benefits can a fleeing felon be eligible for?
What is Buy-In? “Buy-in” is the procedure whereby the Oklahoma Health Care Authority (OHCA) pays the client’s Medicare premium through the Centers for Medicare & Medicaid Services (CMS). DHS determines eligibility and oversees operation of Buy-in Program CMS oversees Medicare program Social Security Administration (SSA) enrolls people in Medicare The Buy-in programs are QMB, SLMB […]
Buy-In Process Flowchart Buy-in is certified (QMB, SLMB, or QI-1) and OKDHS sends Buy-In (accretion) requests to CMS in Baltimore, MD. Client must be on Medicare, or going on the next month, before a Buy-In benefit can be coded on the case. If a worker adds a client to a buy-in benefit when the client […]
If there are any issues with the Buy-In, look over the following items to verify that they are correct on the case: Certification period 12 months 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 […]
Description of the parts of Medicare and where to find more information about Medicare
Specified Low-Income Medicare Beneficiaries (SLMB) – means individuals who, except for income, meet all of the eligibility requirements for QMBP eligibility and are enrolled in Medicare Part A. When approved for SLMB, Medicaid pays for the Medicare Part B premium. Policy regarding this term is located at: Public Assistance Procedures (SoonerCare): 340:65-3-1. Determination of eligibility; […]