Policy & Procedure
What is the policy for computing variable SMI?
What is SM 00712.020
Terminates COM plus 1 Month if the termination is retroactive.
What is R-SMI
Last day of the 36th month of a successful transplant
What is Transplant
Premium Collections
What is PAIDS
HA award letter for ESRD with Medicare already?
What is a E3621
What policy deals with the termination of SMI Entitlement?
What is HI 00820.035
What SIC is used when suspending benefits via MACADE for LESSDO.
What is the SIC of "MB".
Last day of the 12th month dialysis ends
What is Dialysis
Premium Liability
What is Payables
is used when no current HI/SMI is on MBR or when processing an Amended(new) Date of entitlement to R-SMI/R-Hi
What UTI do I use?
What is Cert 31
What is the policy for GHP under TRICARE?
What is HI 00805.325
Medicare Determination Form
What is SSA 892-U3.
Occurs when the premium deducted for SMI
is more than the monthly benefit amount.
What is LESSDO
Provide the Policy that gives verification on the DED/ADD item codes for SCFR 2?
What is SM 00510.584
Anyone required to pay SMI premiums by direct remittance will receive bill
What is CMS-500
What is the policy for Direct Billing System?
What is SM 00711.001
What screen is the Primary documentation that claimant has ESRD
CMS-2728-U3
includes all billing and premium payment information for insured and uninsured BICs with SMI and/or Premium HI.
What is DBS
Name 4 ways that (SMI) payments are collected in a Non-Pay month?
What is Direct remittances, Remittances on a group basis by an employee, Deduction from monthly benefits, and 3rd party state buy in.
The E4030 exhibit notice is available for use in Monthly Benefit Amount (MBA) Less Than Premium Amount (LESSDO) scenarios when the SMI premium deduction reduces the monthly benefit payable (MBP) to less than zero, in single entitlement or dual entitlement cases where payments are separate, and benefit payments are suspended (S9/LESSDO). This suspense can occur on an initial cash award, start of SMI entitlement, or change in SMI premium amount
What UTI do I use?
What is E4030
What is the policy for BIC "T" ESRD Initial Award?
What is SM 00850.605.
If the propagated information is incorrect, BA must correct it by taking the following steps:
Go to #04 Shared Processes off of Main Menu
. Code SSN and Claimant’s name, select #2 update and #2 client access data
Enter #2 in access section, enter #10 – HEALTH INSUR/DIALY/TRANSPLANT (HIKD) in client data selection Make necessary changes and proceed to MACADE action
allows you to access MPBQ (Premium Due Balance Query), MBHQ (Billing History Query), MPPQ (Premium Payment Query) and MPAQ (Premium Due Adjustment Query)
What is MDBS
Informal Waivers can not be included on your SCFR.
True or False
What is TRUE
It cannot be used if the prior year(s) premium balance is more than 3 months’ premiums, what UTI's am I?
The HBN001 and HIB225.