Family and Children's Medicaid MA-3525 MEDICARE ENROLLMENT & BUY-IN
VII. RECIPIENT ENROLLMENT IN BUY-IN
a. Obtain the Medicare claim number including suffix or Railroad Retirement number from the Medicare card. Verify name, DOB, and RSDI on card or SOLQ.
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(VII. A. 2)
b. Enter this number in the RSDI Claim Number block on the DSS-8125. Note: Do not enter an SSI number.
c. Refer to the Social Security Beneficiary Identification Codes for a valid Medicare suffix or Railroad Retirement prefix.
3. Electronic accretions are not processed for open/shut cases. Complete a DMA-5004, Buy-In Clerical Action, for open/shut cases with buy-in eligibility. See Section VI. B. 3. c. for instructions.
Electronic accretions are not processed for cases authorized for retroactive coverage, when the ongoing period pends due to a deductible. Complete a DMA-5004, Buy-In Clerical Action, for cases when buy-in is applicable.
B. Actions Taken By State/Medicaid or Claims Processing Contractor to Initiate Buy-In
1. An electronic file is created monthly for all recipients who do not have buy-in but have RSDI claim numbers on EIS indicating potential eligibility for Medicare Part B.
a. This file is prepared by the Medicaid claims processing contractor and submitted to CMS in Baltimore by the 25th of each month.
b. The file contains the same information that is on the State Eligibility Information System (EIS) file.
c. Information submitted to CMS in Baltimore is checked against the Health Insurance Master Record.
2. The transactions sent to CMS are shown on a monthly printout called the List of Actions sent to Baltimore. A copy of the List of Actions is mailed to the county each month for information and reference. Refer to Part A and Part B Buy-In Transaction Codes, to see transactions.
3. CMS processes the transactions and returns the responses to the State in the next buy-in cycle. State buy-in files are updated upon receipt of acknowledgement from CMS that the transactions have been successful. This exchange of information can take up to 90 days. The county may verify from the SOLQ to determine if buy-in is accomplished.
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C. Accretions By SSA
SSA will automatically enroll any Medicaid recipient in buy-in who identifies himself as Medicaid when making application for Medicare Part B.
The SSA district office must contact the county dss to verify:
1. Medicaid authorization date;
2. Medicaid aid program/category;
3. Medicaid classification;
4. County of residence;
5. Individual ID number.
D. Manual Accretions
1. The DMA-5004, Buy-In Clerical Action, is designed to report those cases in which the electronic process has failed to enroll the person in buy-in.
a. Send a DMA-5004, Buy-In Clerical Action, 90 days or sooner for Part D, after the Medicaid application has been approved and the recipient is not on buy-in after verification on the SOLQ.
b. Send a DMA-5004, Buy-In Clerical Action, for SSI recipients authorized for Medicaid by the county for a retroactive period at the time of approval. Buy-in for retroactive authorization will not be processed electronically for SSI recipients.
c. Send a DMA-5004, Buy-In Clerical Action, for situations as referenced previously in sections VI. B. 3. c. and d. Follow instructions for completion that are found on the reverse side of the form.
2. Actions to be taken by the IMC
a. Verify the Medicare claim number, name, DOB and entitlement date from:
(1) Most current Bendex or SOLQ.
(2) State Online Query (SOLQ). Page 3 of the SOLQ response contains valid effective dates for the recipient's Health Insurance (HI; Medicare Part A) and Supplemental Medical Insurance (SMI; Medicare Part B). Refer to the EIS Manual, EIS 1107, State Online Query/Third Party Query, VII. B. 2., for an explanation of the information on the screen for Part A and/or Part B effective dates.
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(VII. D. 2.)
b. Compare the following information on EIS to the SOLQ, Bendex and/or Medicare card for an exact match. Refer to the EIS Manual, EIS 1107, State Online Query/Third Party Query.
(1) Medicare claim number (Title II Claim Account Number on SOLQ);
(2) Medicare claim number suffix;
(3) Name, 1st, middle initial and last.
c. Buy-in does not process without an exact match on the claim number, suffix, and name. Never use the claim number and suffix that appears on the SSI check.
d. If the information is an exact match, and a buy-in accretion action has not appeared on the "List of Actions," complete the DMA-5004, Buy-In Clerical Action. Attach the SOLQ response and send to the Medicaid claims processing contractor.
e. If the information does not match:
(1) Change the information in EIS to agree with the information on the SOLQ response;
(2) Complete the DMA-5004, Buy-In Clerical Action. Attach the SOLQ response and send to the Medicaid claims processing contractor.
f. Do not send a DMA-5004, Buy-In Clerical Action, to Medicaid until the recipient has applied, been enrolled and is a recipient of Medicare.
g. The IMC must send a DMA-5004, Buy-In Clerical Action, when a new applicant is authorized for CAP services; otherwise, buy-in does not process.
E. Electronic Deletions from Buy-In
1. Electronic deletion is a process to terminate a recipient from buy-in when the case is terminated or a recipient is deleted from Medicaid.
2. Deletions are handled by the same method and on the same 90-day time schedule as accretions.
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F. Effects of Accretion and Deletion on the SSA or RR Check
1. Because it may take up to 90 days for accretion to take place, two to three premiums are deducted from the recipient's check after the effective date of buy-in.
a. Premiums paid by the recipient after the buy-in effective date are refunded to the recipient by Social Security or Railroad Retirement.
b. When the recipient is on buy-in and premiums continue to be deducted from the Social Security check, the IMC must verify the premium deduction and indicator on SOLQ, or contact the Buy-In Coordinator in the Claims Analysis Unit at DMA to confirm Medicaid buy-in accretion has taken place.
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(VII. F.1. b)
Once accretion has been verified, the IMC should call the representative at the local Social Security office or e-mail their office at www.ssa.gov/ for corrective action. The recipient’s name, HIC number, and Social Security number will be needed for this request. The Social Security representative will complete and submit a Manual Development Worksheet (MDW) to the Medicare Payment Center to correct Payment Center records.
Do not contact the SSA office unless the recipient is listed on the SOLQ with a premium amount or the Buy-In Unit has verified accretion.
c. Please allow 90 days after Medicaid approval before inquiring with Social Security Administration about refunds.
2. Because it takes 90 days for buy-in to terminate after the case is terminated (or the individual is deleted from the case), Medicaid pays two or three premiums after termination of benefits.
a. Premiums paid by Medicaid after termination/deletion are credited to the State.
b. Premium amounts are deducted in a lump sum from the individual's next SSA/RR check.