Navigating the Buy-in
October 1, 2009
Situation #1 Nancy
Nancy is turning 65 next month. She will
receive $867.00 in RSDI starting next month.
Should this recipient Buy-in for Part A?
No Yes If yes what date? __________
Should this recipient Buy-in for Part B?
No Yes If yes what date? __________
Answer: Situation #1 Nancy
Nancy is turning 65 next month. She will
receive $867.00 in RSDI starting next month.
Should this recipient Buy-in for Part A?
No, it is free.
Should this recipient Buy-in for Part B?
Yes, 11/01/09.
Situation #2 Carl
Carl is 58 years old and receives SSI of
$674.00 for disability and MSA of $81.00.
Should this recipient Buy-in for Part A?
No Yes If yes what date? __________
Should this recipient Buy-in for Part B?
No Yes If yes what date? __________
Answer: Situation #2 Carl
Carl is 58 years old and receives SSI of
$674.00 for disability and MSA of $81.00.
Should this recipient Buy-in for Part A?
No, he does not have Medicare eligibility.
Should this recipient Buy-in for Part B?
No, he does not have Medicare eligibility.
Situation #3 Lenny
Lenny is 32 and receives RSDI of $400.00 and
SSI of $294.00. His Medicare began 9/1/09.
Should this recipient Buy-in for Part A?
No Yes If yes what date? __________
Should this recipient Buy-in for Part B?
No Yes If yes what date? __________
Answer: Situation #3 Lenny
Lenny is 32 and receives RSDI of $400.00 and
SSI of $294.00. His Medicare began 9/1/09.
Should this recipient Buy-in for Part A?
No, it is free.
Should this recipient Buy-in for Part B?
Yes, 9/01/09. Lenny is categorically eligible
for the buy-in due to SSI and MA even if
the worker does not open QMB.
What is the Buy-in?
The Buy-in is a 2-part data exchange
between DHS and CMS that pays Medicare
premiums for eligible individuals.
 Part 1: DHS sends data via MMIS to CMS, to
communicate which MHCP recipients appear
eligible, or have lost eligibility, to have their
Medicare A or B premiums paid by the State
of Minnesota.
 Part 2: CMS responds. They will either
accept, reject, or modify the DHS request.
MAXIS and the Buy-in
MAXIS has to have the correct information
before the buy-in process can work correctly
in MMIS.
 STAT UNEA must have the income start date
 STAT MEDI must be entered including the
Medicare claim number
 Be approved on a Medicare Savings Program
(MSP) in Health Care Eligibility
Buy-in Eligibility
To be eligible for the Buy-in a person must qualify for
Medicare and:
 Be enrolled in an MSP
 Be enrolled in MA, entitled to premium-free Medicare
Part A, and be enrolled in one of the following
programs:






Minnesota Supplemental Aid (MSA)
Minnesota Family Investment Program (MFIP)
1619(a) or 1619(b) SSI status
IV-E Adoption Assistance
IV-E Foster Care
Group Residential Housing (GRH)
Buy-in Referral
Refer people not enrolled in Medicare who are eligible
for the buy-in to SSA.
 Check TPQY in MAXIS to ensure there are no
discrepancies in the person’s name or DOB
 Complete and send DHS-3439 Medicare Buy-in
Referral Letter
 Allow 60 days to apply for Medicare and return
confirmation portion of the referral letter
 Update STAT PBEN in MAXIS and track return of
letter on DAIL/TIKL
 Process MSP eligibility upon receipt of the letter
Previous Medicare Entitlement
Do not refer people who have Part A only or
Part B only or who have had Medicare
previously. They are already known to SSA
and do not need to reapply for Medicare to
have entitlement reestablished.
Not Entitled to Premium-Free Part A
 People who qualify for Medicare, but are not entitled
to premium-free Medicare Part A, including people
who receive SSI only who are age 65 or older, must
be enrolled in QMB to participate in the buy-in. QMB
will pay the Medicare Part A premium, the Medicare
Part B premium, and other Parts A and B cost
sharing.
 Do not approve retroactive SLMB eligibility for any
enrollee who must pay a premium to get Medicare
Part A, even if the referral form shows a Medicare
begin date in a past or current month. Approve
prospective QMB eligibility only for these enrollees.
Accrete/Delete
The communication from DHS (via MMIS) to
CMS is called Accrete/Delete.


This process runs 8 working days from the end of
the month
Everyone who has active MHCP is evaluated to
see if they have become eligible, remain eligible,
or have lost eligibility for the buy-in
Accrete/Delete – October 2009
Sun
Mon
Tues
Wed
Thur
Fri
Sat
2
9
16
3
10
17
23
6
30
1
24
4
11
5
12
6
13
7
14
1
8
15
18
19
20
25
26
5
27
4
21
8
28
3
22
7
29
2
31
The MAXIS/MEC2/MMIS Production calendar is available on SIR.
Buy-in Apply
The CMS response to Accrete/Delete is
called Buy-in Apply
 Buy-in Apply runs on the 6th working day of
the month (roughly 3 weeks after
Accrete/Delete).
 Buy-in Apply may also contain CMS-initiated
data that can impact buy-in such as:



SSI participation
Medicare begin or end dates
Medicare ID number changes
Buy-in Apply for November 2009
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
2
1
3
2
4
3
5
4
6
5
7
8
9
6
10
11
12
13
14
15
16
17
18
19
20
21
22
29
23
30
24
25
26
27
28
The MAXIS/MEC2/MMIS Production calendar is available on SIR.
Buy-in for Part A
 Must have Medicare ID# and Part A
participation dates on RMCR, which can be
interfaced from STAT/MEDI.
 Requires program eligibility of QMB or QWD.
 Must not have an entitlement/non-entitlement
code of “E” on RBUY.
 The Part A calculated accrete request date
will be the later of RELG or RMCR dates.
Part A Information on
RMCR and RBUY
NEXT: RSVL 10/20/08 10:49:16 MMIS RECIP MEDICARE-RMCR TILMM02 10/16/08 PWMW134
01234567
12/18/1933 *
BUYIN
BETTY
X *
MEDICARE ID: 333224444M
**********************************
RSN: *
- - - - - - - - - - - - M E D I C A R E
P A R T
A - - - - - - - - - - - MEDICARE PART A BENEFITS EXHAUSTED (Y/N):
DATE:
BEGIN DATE END DATE SRC PPHP (Y/N)
BEGIN DATE END DATE SRC PPHP (Y/N)
07/01/08
99/99/99
M
*
NEXT: RBYB 10/20/08 11:16:44
MMIS RECIP BUYIN-RBUY
TILMM02 10/16/08 PWMW133
01234567
12/18/1933 *
BUYIN
BETTY
X *
MEDICARE ID: 333224444M
**********************************
ENTITLE/NON-ENTITLE: Y
PART (A) ACCRETE REQUEST DATE:
ACCRETE DATE:
PART (A) DELETE REQUEST DATE:
DELETE DATE:
--------------------------BUYIN MONTHLY TRANSACTIONS--------------------------TXN
TXN
SUB
ACCRETE
DELETE
----- PREMIUM -----DATE
CODE
CODE
DATE
DATE
AMOUNT
DATE
Buy-in for Part B
 Must have Medicare ID# and Part B
participation dates on RMCR, which can be
interfaced from STAT/MEDI
 Program eligibility under QMB or SLMB
(including QI-1) or
 Categorical eligibility of
MA with eligibility types 09, 15, 16, 25 or
 Other MA with “M” indicator (MFIP) or
 Other MA with MSA/GRH or SSI start dates
on RMSC

Part B Information on
RMCR and RMSC
NEXT: RSVL 10/20/08 10:49:16 MMIS RECIP MEDICARE-RMCR TILMM02 10/16/08 PWMW134
01234567
12/18/1933 *
BUYIN
BETTY
X *
MEDICARE ID: 333224444M
**********************************
RSN: *
- - - - - - - - - - - - M E D I C A R E
BEGIN DATE END DATE SRC PPHP (Y/N)
07/01/08
99/99/99
M
P A R T
B - - - - - - - - - - - BEGIN DATE END DATE SRC PPHP (Y/N)
*
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
PAGE
S/EXT
N/EXT
OOPS
HELP
NEXT: RHCI 10/20/08 11:34:48 MMIS RECIPIENT INFO-RMSC TILMM02 10/16/08 PWMW12M
01234567
12/18/1933 *
BUYIN
BETTY
X *
********************************** - - - - M I S C E L L A N E O U S - - - SSI BEGIN DATE: 08/01/2005
SSI END DATE: 99/99/9999
RSDI INCOME (Y/N):
RAILROAD INCOME(Y/N):
RSDI BEGIN DATE:
RSDI END DATE:
MSA/GRH GRANT BEG DATE: 12/01/2007
MSA/GRH GRANT END DATE: 99/99/9999
MFIP BEGIN DATE:
MFIP END DATE:
PREGNANCY BEGIN DATE:
PREGNANCY END DATE:
Determining the
Part B Accrete Request Date
The Medicare begin date is compared to RELG
begin date and the later of the 2 dates is
remembered as DATE 1.
For categorical buy-in, further date checking is
required. The MSA/GRH date is compared to
SSI date on RMSC and the earlier date is
remembered as DATE 2.
The Part B calculated accrete request date will
be the later of DATES 1 and 2.
Calculating DATE 1
In this example DATE 1 would be 06/01/08
NEXT: RIDS 06/16/08 09:26:24
MMIS ELIGIBILITY-RELG
TILSN83 04/24/05 PWMW127
00000000
00/00/0000 *
SMITH
SAM
S *
**********************************
- - - - - - - - - - - - - - E L I G I B I L I T Y - - - - - - - - - - - - - 01 PRG: MA
ELIG TY: EX
CASE: 00000000
ELIG BEGIN: 01/01/08
ELIG END: 99/99/99 CFR: 018 STATUS: A REASON: 99
STATUS DATE: 01/03/08 DATE ADDED: 01/03/08 INDICATOR: N APPL DT: 01/01/08
NEXT: RSVL 06/16/08 09:26:52 MMIS RECIP MEDICARE-RMCR TILSN83 4/24/05PWMW134
00000000
00/00/0000 *
SMITH
SAM
S *
MEDICARE ID: 123456789A
**********************************
RSN: *
- - - - - - - - - - - - M E D I C A R E
P A R T
B - - - - - - - - - - - MEDICARE PART B BENEFITS EXHAUSTED (Y/N):
DATE:
BEGIN DATE END DATE SRC PPHP (Y/N)
BEGIN DATE END DATE SRC PPHP (Y/N)
06/01/08
99/99/99
F
Calculating DATE 2
In this example DATE 2 would be 01/01/08
NEXT: RHCI 06/16/08 09:43:50 MMIS RECIPIENT INFO-RMSC TILSN83 04/24/05 PWMW12M
00000000
00/00/0000 *
SMITH
SAM
S*
********************************** - - - - M I S C E L L A N E O U S - - - SSI BEGIN DATE: 03/01/08
SSI END DATE: 99/99/99
RSDI INCOME (Y/N):
RAILROAD INCOME(Y/N):
RSDI BEGIN DATE:
RSDI END DATE:
MSA/GRH GRANT BEG DATE: 01/01/08
MSA/GRH GRANT END DATE:
MFIP BEGIN DATE:
MFIP END DATE:
PREGNANCY BEGIN DATE:
PREGNANCY END DATE:
Determining the
Part B Accrete Request Date
DATE 1 and DATE 2 are now compared to
determine the accrete request date
In this example:


DATE 1 is 06/01/08 (Medicare begin date)
DATE 2 is 01/01/08 (SSI begin date)
DATE 1 is the later of those 2 dates, so the Part
B accrete request date is calculated to be
06/01/08.
Determining the Accrete Request
Date – Part A or B
The next step in determining the accretion date is
checking whether buy-in previously existed. If so, the
new accrete request date must be after the prior
period.
NEXT: RBYD 06/16/08 09:02:16
MMIS RECIP BUYIN-RBYB
TILSN83 04/24/05 PWMW133
00000000
00/00/0000 *
SMITH
SAM
S *
MEDICARE ID:
123456789A
**********************************
ENTITLE/NON-ENTITLE: *
PART (B) ACCRETE REQUEST DATE:
ACCRETE DATE:
06/01/05
PART (B) DELETE REQUEST DATE:
DELETE DATE:
06/30/08
--------------------------BUYIN MONTHLY TRANSACTIONS-----------------------TXN
TXN
MCARE ACCRETE
DELETE
----- PREMIUM --DATE
CODE
PART
DATE
DATE
AMOUNT
DATE
The calculated accrete request date was 06/01/08. In
this situation the actual accrete request date sent to
CMS would be 07/01/08.
Determining the Accrete Request
Date – Part A or B
 The accrete request date is systematically
limited to 6 months retroactive to the current
month.
 For example, if there is a delayed eligibility
determination and the begin date is more
than 6 months in the past, the buy-in start
date would be limited to 6 months ago.
 Manual requests allow for buy-in to cover the
period earlier than 6 months ago. MMIS User
Services can key these requests.
Situation #4 Trisha
Trisha is 39 years old and receives RSDI of $1000.00 per month for
disability starting 11/1/06. She has Medicare Part A that began
11/1/08 and she refused Medicare Part B when it was offered in
11/1/08. She came in today to apply for Health Care programs
and is eligible for MA with a Spenddown effective 9/1/09. She
has opted not to apply her Medicare premium to her
Spenddown.
Should this recipient Buy-in for Part A?
No Yes If yes what date? __________
Should this recipient Buy-in for Part B?
No Yes If yes what date? __________
Answer: Situation #4 Trisha
Trisha is 39 years old and receives RSDI of $1000.00 per month for
disability starting 11/1/06. She has Medicare Part A that began
11/1/08 and she refused Medicare Part B when it was offered in
11/1/08. She came in today to apply for Health Care programs
and is eligible for MA with a Spenddown effective 9/1/09. She
has opted not to apply her Medicare premium to her
Spenddown.
Should this recipient Buy-in for Part A?
No, it is free.
Should this recipient Buy-in for Part B?
Technically Yes she should buy-in for Part B 9/1/09, however
there are no Part B begin dates on RMCR so she will not be
picked up on the buy-in until there are dates. This panel
interfaces from the STAT MEDI panel.
Situation #5 Joe
Joe is 32 and receives RSDI in the amount of $420.00
that began 9/1/07 and SSI in the amount of $274.00
that began 8/1/07 for disability. He is Medicare
eligible beginning 9/1/09. He applied for Health Care
programs on 10/1/09. He is eligible for MA 10/1/09
as he did not request retroactive coverage.
Should this recipient Buy-in for Part A?
No Yes If yes what date? __________
Should this recipient Buy-in for Part B?
No Yes If yes what date? __________
Answer: Situation #5 Joe
Joe is 32 and receives RSDI in the amount of $420.00 that began
9/1/07 and SSI in the amount of $274.00 that began 8/1/07 for
disability. He is Medicare eligible beginning 9/1/09. He applied
for Health Care programs on 10/1/09. He is eligible for MA
10/1/09 as he did not request retroactive coverage.
Should this recipient Buy-in for Part A?
No, it is free.
Should this recipient Buy-in for Part B?
Yes 10/01/09 if picked up by the Categorical Buy-in due to the
receipt of SSI with MA. 09/01/09 if opened on a MSP in
MAXIS and coded on RELG in MMIS.
Determining Part A Delete Date
 Medicare end date is populated on RMCR
or
 Program eligibility has ended on RELG
or
 Entitle/Non-entitle code of “E” for Part A
received
The delete date will be the eligibility or Medicare
end date or the end of the previous month in
the case of the “E” coding.
Determining Part B Delete Date
 Medicare end date is populated on RMCR
or
 Program eligibility has ended on RELG
or
 Categorical eligibility has ended on RELG or
RMSC (elig type, “M” Indicator, SSI,
MSA/GRH)
The delete date will be the eligibility/Medicare
end date, or the end of last month.
Accrete/Delete Request Dates
RBUY and RBYB each have accrete and delete
request date fields to indicate whether
Accrete/Delete has determined a change in
buy-in status or whether a manual request
has been keyed:
NEXT: RBYB 06/19/08 08:31:37
MMIS RECIP BUYIN-RBUY
WMW1740 06/15/06
PWMW133
00000000
03/08/1937 *
SMITH
SAM
R *
MEDICARE ID: 123456789A
**********************************
ENTITLE/NON-ENTITLE: Y
PART (A) ACCRETE REQUEST DATE: 06/01/08
ACCRETE DATE:
PART (A) DELETE REQUEST DATE:
DELETE DATE:
RBUY after Buy-in Apply
NEXT: RBYD 06/16/08 09:02:16
MMIS RECIP BUYIN-RBUY
TILSN83
00000000
00/00/0000 *
PIPER
PETER
R *
MEDICARE ID:
123456789A
**********************************
ENTITLE/NON-ENTITLE: *
PART (A) ACCRETE REQUEST DATE:
ACCRETE DATE: 09/01/08
PART (A) DELETE REQUEST DATE:
DELETE DATE: 99/99/99
--------------------------BUYIN MONTHLY TRANSACTIONS--------------------------TXN
TXN
SUB
ACCRETE
DELETE
----- PREMIUM -----DATE
CODE
CODE
DATE
DATE
AMOUNT
DATE
10/01/08
1161
09/01/08
846.00
09/01/08
Basics of Buy-In
TXN Codes
The MMIS User Manual has a complete list of Buy-In
related transactions and Worker Messages, along with
guidelines for worker action
Basics of Buy-In TXN Codes
Accrete/Delete transaction codes
The txn codes we send to CMS do not appear on
RBUY/RBYB but are useful to know in relation to the
response codes
 51 =
delete request
 53 =
delete request due to death
 61 =
accrete request
 75 =
simultaneous accrete/delete request
 99 =
informational
Basics of Buy-In TXN Codes
When an accrete/delete transaction is accepted
by CMS we will get these response codes
 1161 = CMS accepted an accrete request
 1751 = CMS accepted a delete request
 1753 = CMS accepted a delete request due to DOD
When an accrete/delete transaction is rejected
by CMS we will get these response codes:
 2051, 2053 = CMS rejects deletion request
 2161, 2175 = CMS rejects an accretion request
Basics of Buy-In TXN Codes
CMS-initiated transactions:
 41 = ongoing buy-in
 14, 15 = CMS reports Medicare entitlement ended
 16 = CMS reports a DOD
 1728 = CMS reports potential residence outside of
Minnesota
 44 = Subsidy for Medicare Part B premium was
received by CMS
 45 = Subsidy for Medicare Part B premium has
ended
Navigating the Buy-In
Higher Priority Worker Messages
Buy-In Worker Messages
BUY-IN ACCRETION REJECTED FOR PART (A or B).
REASON CODE (A, B, C, D, or E). REVIEW
 Txn Code: 2161
 Definition: Accrete request was rejected due to
MMIS/CMS discrepancies
 MMIS: creates buy-in occur span with attempted accrete
date and removes Accrete Request Date
 Action: depends on reason code
 Why Important: If enrollee is only Medicare eligible based
on premium payment, enrollment in Medicare A and B is
delayed until rejection is resolved.
Buy-In Worker Messages
 A: No match to Medicare ID# on the Electronic Data
Base (EDB). Check BENDEX or send new TPQY.
 B: Name, DOB, or sex code discrepancy between
MMIS and EDB. Verify accuracy and update
MAXIS/MMIS accordingly.
 C for Pt A: Part A is free, or person does not have
Part A. Verify Part A dates, and update MAXIS/MMIS
accordingly.
 C for Pt B: Accrete request is based on QM or SL
and EDB shows no Part A coverage. Confirm Pt A
eligibility (BENDEX, TPQY). If recipient is not
eligible, close QM or SL.
Buy-In Worker Messages
 D for Pt A: no record of Pt B buy-in, which is required
before Pt A accretion.
 D for Pt B: accrete attempt is based on QWD, and
QWD does not pay for Part B.
 E: no Medicare entitlement. If recipient appears
entitled to Medicare, refer to SSA.
For all these worker messages: If data in MMIS has
been verified as correct, contact MMIS User
Services.
TIP: check the Entitlement/Non-Entitlement code on
RBUY and RBYB when this worker message is
received.
Entitlement/Non-Entitlement
Example
NEXT: RBYB 06/20/08 11:25:30
MMIS RECIP BUYIN-RBYB
FMLMMBP
00000000
00/00/00000 *
BIRD
BIG
A *
MEDICARE ID:
000000000A
**********************************
ENTITLE/NON-ENTITLE: C
PART (B) ACCRETE REQUEST DATE:
ACCRETE DATE:
PART (B) DELETE REQUEST DATE:
DELETE DATE:
--------------------------BUYIN MONTHLY TRANSACTIONS--------------------------TXN
TXN
SUB
ACCRETE
DELETE
----- PREMIUM -----DATE
CODE
CODE
DATE
DATE
AMOUNT
DATE
1
10/01/08
2161
E
06/01/08
Pt B Entitlement/Non-Entitlement codes available via PF12:










C
D
F
G
N
R
S
T
W
Y
NOT ENTITLED NO DISABILITY
COVERAGE DENIED
TERMINATED INVALID VOIDED
ENTITLED GOOD CAUSE
NOT ENTITLED FOREIGN OR DUAL
REFUSED BENEFITS
TERMINATED NO ENTITLE ESRD
TERMINATED NON PAY PREMIUM
VOLUNTARYWITHDRAWAL
ENTITLED PREMIUM PAYABLE
Buy-In Worker Messages
BUY-IN TERMINATED DUE TO DEATH. VERIFY
DATE OF DEATH
 Txn: 16 A/B
 Definition: CMS deleted recipient from buy-in due to
death
 MMIS: adds delete date on RBUY/RBYB and ends
RMCR span
 Action: verify recipient’s status. If death is incorrect
refer client to SSA to correct and reopen Medicare. If
deceased, add DOD and close case.
Buy-In Worker Messages
NEW MEDICARE CLAIM NBR REPORTED ON BUYIN FILE
 Txn: 23xx
 Definition: Medicare number changed.
 MMIS: new claim number added to MMIS, prior
number moves to RIDS
 Action: update claim number in MAXIS
Buy-In Worker Messages
SSA REPORTS NON MN ADDRESS.
VRFY/UPDATE CLIENT ADDRESS
 Txn: 1728
 Definition: CMS deleted from buy-in because
another state has requested accretion or SSI
records indicate residence in another state.
 MMIS: delete date added to RBUY/RBYB
 Action: verify client address. If still a
Minnesota resident, refer to SSA. If not,
close case.
Buy-In Worker Messages
CMS REPORTS SSI BEGIN. MMIS UPDATED.
 Txn: 86
 Total txn: 590 (March)
 Definition: Medicare beneficiary became SSI eligible
(with potential buy-in eligibility). Txn may also include
Part A entitlement date
 MMIS: SSI start date added to RMSC, and Medicare
start date if included. May trigger a categorical
accretion if other factors met.
 Action: verify SSI amount for effect on other
programs
Buy-In Worker Messages
CMS REPORTS SSI ENDED. RMSC UPDATED
 Txn: 87
 Total txn: 443 (March)
 Definition: SSI eligibility ended (can also end buy-in
unless meets another basis for buy-in)
 MMIS: deletes SSI Start Date if currently populated
 ACTION: Verify status of SSI payments for other
programs’ use. This may also indicate a temporary
ending of SSI payments.
Buy-In Worker Messages
SSA REPORTS RECIPIENT NO LONGER ELIGIBLE
FOR MEDICARE
 Txn: 15
 Definition: deleted from buy-in because Medicare
ended
 MMIS: delete date added to RBUY/RBYB and
Medicare end date added on RMCR
 Action: review client record, particularly entitlement
coding. If Medicare eligibility appears to exist, refer
client to SSA. Re-open Medicare if eligibility is reestablished.
How to Properly End a MEDI Span
 When a 15 txn is received from CMS,
STAT/MEDI needs to be updated.
However, it’s not as simple as just adding an
end date if Medicare dates were previously
verified in MAXIS…
If MAXIS looks like this:





















06/19/06 11:17:28
CAF Question 44
MAXIS
Medicare (MEDI)
FMCGNAM1
1 Of 1
Ref Last First M * Ref Nbr: 01 SMITH, SAM
01 SMITH SAM*
* Medicare Claim Nbr: 999 99 9999 A__
Ver: V
* Part A Premium: $ ________ Part B Premium: $ 88.50
* Buy In Begin Date: 04 01 00 Buy In End Date: __ __ __
* Qualified Working Disabled Individual (Y/N): N
*
Apply Premiums To Spdn/Budgets (Y/N): N
* Apply Premiums To Spdn/Budgets Thru (MM/YY): __ __
*
Part A
Part B
* Begin Dt End Date Ver Begin Dt End Date Ver
* 04 01 00 __ __ __
V
04 01 00 __ __ __
V
* __ __ __ __ __ __
__ __ __ __ __ __
* __ __ __ __ __ __
__ __ __ __ __ __
* __ __ __ __ __ __
__ __ __ __ __ __
* Shift PF7/PF8 To Scroll Part A/B Dates
Mode: D Function: STAT Case Nbr: __999999 Month: 06 06 Command: ____ __ __
Sv: 00
PW: X100000 SW:
Updated: 11 26 05 User: PWGAP53
And MMIS looks like this:
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NEXT: RSVL 06/19/06 11:20:36 MMIS RECIP MEDICARE-RMCR WMW1740 06/15/06
PWMW134
00000000
00/00/0000 *
SMITH
SAM
M*
MEDICARE ID: 999999999A
**********************************
RSN: 1
- - -- - - - - -- - - M E D I CAR E PART A- - - - - -- - - - - MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE:
BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP
04/01/00 99/99/99 F
*
- - -- - - - - -- - - M E D I CAR E PART B - - - - -- - - - - -BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP
04/01/00 99/99/99 F
*
And if you do this in MAXIS…
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06/19/06 11:17:28
CAF Question 44
MAXIS
Medicare (MEDI)
FMCGNAM1
1 Of 1
Ref Last First M * Ref Nbr: 01 SMITH, SAM
01 SMITH SAM*
* Medicare Claim Nbr: 999 99 9999 A__
Ver: V
* Part A Premium: $ ________ Part B Premium: $ 88.50
* Buy In Begin Date: 04 01 00 Buy In End Date: __ __ __
* Qualified Working Disabled Individual (Y/N): N
*
Apply Premiums To Spdn/Budgets (Y/N): N
* Apply Premiums To Spdn/Budgets Thru (MM/YY): __ __
*
Part A
Part B
* Begin Dt End Date Ver Begin Dt End Date Ver
* 04 01 00 __ __ __ V
04 01 00 __ __ __ V
* 04 01 00 05 31 06
04 01 00 05 31 06
* __ __ __ __ __ __
__ __ __ __ __ __
* __ __ __ __ __ __
__ __ __ __ __ __
* Shift PF7/PF8 To Scroll Part A/B Dates
Mode: D Function: STAT Case Nbr: __999999 Month: 06 06 Command: ____ __ __
Sv: 00
PW: X100000 SW:
Updated: 11 26 05 User: PWGAP53
…MMIS will look like this:
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PWMW134
00000000
00/00/0000 *
SMITH
SAM
M*
MEDICARE ID: 999999999A
**********************************
RSN: 1
- - -- - - - - -- - - M E D I CAR E PART A- - - - - -- - - - - MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE:
BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP
04/01/00 99/99/99 F
*
04/01/00 05/31/06 M
- - -- - - - - -- - - M E D I CAR E PART B - - - - -- - - - - -BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP
04/01/00 99/99/99 F
*
04/01/00 05/31/06 M
To end a verified Medicare span:
Complete a PF11 on STAT/MEDI. Include the
verified end date
Fax the proof of the end date to (651) 4317419, including the PF11 reference number
on the fax.
See TE02.07.453 or QTIP 114 for complete
instructions
Navigating the Buy-In
SSI recipient turning 65 scenario
SSI Recipient Turns 65
Federally-funded MA enrollees who receive SSI
only and who become age 65 or are older,
must enroll in Medicare Part A and Part B if
they are eligible.
Failure to enroll is considered non-cooperation
with third party liability and results in
ineligibility for MA.
SSI Recipient Turns 65
 These enrollees are required to pay a
premium for BOTH Part A and Part B
 DHS pays these costs directly to CMS
through the buy-in when QMB is approved
and entered in MMIS.
 Enrollees must apply and be determined
eligible for Medicare before these payments
can begin through the buy-in.
SSI Recipient Turns 65
MMIS User Services generates monthly reports to
identify these MA enrollees three months before
their 65th birthday and sends MAXIS emails to
associated workers.
This contact is designed to help workers initiate the
Medicare enrollment process one month earlier
than prompted by the current MMIS worker
message “Client turns 65. Enter Medicare claim
number” that is issued two months in advance for
all recipients turning age 65.
SSI Recipient Turns 65
When notified by MMIS User Services:
 Check TPQY in MAXIS for discrepancies in:


Enrollee Name - first, last, middle initial
Date of Birth
 Send new QURY if TPQY is older than 6
months
 CMS data is shown on the BDXP screen
TPQY Screens
06/20/06 07:35:14
FMLTPAM1
MAXIS
Third Party Query Response (TPQY)
MAXIS Data
Name: JAMES J CASEY
SSN: 569 85 2147
Clm No:
Birthdate: 09 10 1930
SVES Response Date: 03 31 06
Unmatched Data Report Date:
SSN Ver: V
RSDI Record: Y
SSI Record: Y
ID Discrepancy:
Code: V Text:
Qualifying Quarters
Qualifying Quarters Through 12/96:
Qualifying Quarters From 01/97: _
Total Questionable Quarters:
Function: SVES
Case Nbr: ________ Month: 06 06
Command:
TPQY Screens
Beneficiary Data Response (BDXP)
Name: JIM J CASEY
SSN: 569 85 2147 Clm No: 569852147M Dual Entl Nbr:
Payment Status: N DISALLOWED CLAIM
Pay Date
Gross Amt
Net Amt
Birthdate: 09 10 1930
$
$
Railroad Ind:
$
Lump Payment Date:
$
Lump Sum Amt:$
$
Intl Entl Date: 12 90
$
Current Entl Date: 11 03
$
Deferred Payment Date:
$
Susp/Term Date:
$
Response Date: 03 31 06
TPQY Screens
State Data Response (SDXE)
Name: JAMES J CASEY
SSN:
Clm No: 569852147
SSI Appl Date: 11 17 03
Recipient Type: DI DISABLED INDIVIDUAL
Payment Status: C01 CURRENT PAY
Denial Code:
Denial Date:
Onset Date Disa/Blind: 11 01 03
SSI/Opt SSP Elig Date: 11 01 03
Response Date: 03 31 06
Birthdate: 09 10 1930
Fed Liv Arrange: A
Appeals
Appeals
Appeals Decision
Appeals Decision
Disa Pay
Code:
Date:
Code:
Date:
Code: F
SSI Recipient Turns 65
 If a discrepancy exists:


Advise the enrollee of the specifics of the
discrepancy when sending them the referral to
SSA to ensure the error is resolved when
he/she goes to the SSA office to apply for
Medicare
Advise the enrollee to take original
documentation such as a birth certificate or
immigration/naturalization papers with them to
resolve the error
SSI Recipient Turns 65
Complete the County Agency section of the
Medicare Buy-in Referral Letter (DHS 3439)
and provide it to the enrollee with a countyaddressed return envelope. The enrollee
must take this form and the county-addressed
envelope to the SSA when applying for
Medicare. Find DHS 3439 online at:
http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3439-ENG
DHS 3439
SSI Recipient Turns 65
When referring to SSA, update STAT/PBEN:
 Benefit type “19” (Other)
 referral date
 verification code of “5” (Other document)
 DISP (disposition) code of “P” (Pending).
Ref Last First
M * Ref Nbr: 01 CASEY, JAMES J
01 CASEY JAMES J
*
*
Referral
Appl
* Benefit Type
Date
Date
* 19 Other
07 10 08
__ __ __
* __
__ __ __
__ __ __
Ver
5
_
IAA
Date
__ __ __
__ __ __
Disp
P
_
SSI Recipient Turns 65
 Track for return of the letter in 30 days using
DAIL/TIKL.
 Contact the enrollee if the letter has not been
returned at the end of 30 days.
 Determine whether he/she complied with the
request to apply for Medicare.
 Provide a second referral letter if necessary.
Track for an additional 30 days.
SSI Recipient Turns 65
Upon receipt of the completed referral letter, enter the
STAT/MEDI panel:
 Use the Medicare Claim Number from the referral form
(usually SSN + “M”)

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Enter Part A or Part B Premium amounts
Enter Buy-in Begin Date as QMB eligibility begin date
Enter ‘N’ for Qualified Working Disabled Individual
(Y/N):
Enter ‘N’ for Apply Premiums To Spdn/Budgets (Y/N):
Enter Medicare Part A and B begin dates from the
referral form
MEDI Screen
CAF Question 44
Ref Last First
M *
01 CASEY JAMES J
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Medicare (MEDI)
Ref Nbr: 01
1 Of 1
CASEY, JAMES
Medicare Claim Nbr: 569 85 2147 M__
Ver:
Part A Premium: $
423.00 Part B Premium: $
96.40
Buy In Begin Date: 07 01 08 Buy In End Date: __ __ __
Qualified Working Disabled Individual (Y/N): N
Apply Premiums To Spdn/Budgets (Y/N): N
Apply Prem To Spdn/Bdgt Thru Date Or Medi Reimb Dt: __ __
Part A
Part B
Begin Dt
End Date
Ver
Begin Dt
End Date
Ver
07 01 08
__ __ __
07 01 08
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
Shift PF7/PF8 To Scroll Part A/B Dates
Mode: D Function: STAT Case Nbr: __408199
Month: 06 08 Command: ____ __ __
Sv: 90
PW: PWSKC35
SW:
Updated: 06 16 08 User: PWSKC35
Enter-PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10--PF11--PF12--HELP PMI
EXIT CNOTE PNOTE
PREV NEXT EDIT OOPS TRBL INFO
SSI Recipient Turns 65
 Update STAT/HCRE if needed to process
QMB eligibility in HC ELIG


Update Appl/Addendum Request Date with the
date referral form is received
Update Coverage Request Date with the
month QM is to begin
 Approve QMB eligibility and enter in MMIS.
 Do not provide retroactive SLMB coverage,
even if the referral form shows a Medicare
begin date in the past or current month.
HCRE Screen
Ref Last First
M *
01 CASEY JAMES J
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Health Care Application Date: 09/10/05
Ref
Nbr
Name
01 CASEY, JAMES
Appl
Addendum
Request
Date
06 10 08
Coverage
Request
Date
(MM/YY)
07 08
Recv By
Sv Date
__ __ __
Shift PF7/PF8 To Scroll HC Appl/Add Requests
Mode: D Function: STAT Case Nbr: __408199
Month: 06 08 Command: ____ __ __
Sv: 90
PW: PWSKC35
SW:
Updated: 06 16 08 User: PWSKC35
Enter-PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10--PF11--PF12--HELP PMI
EXIT CNOTE
PREV NEXT EDIT OOPS TRBL INFO
SSI Recipient Turns 65
Put in a DAIL/TIKL if the month Medicare begins
is not yet available for processing on MAXIS.
Example:
 Referral letter is received in March stating
Medicare will begin 5-1-09.
 May is not yet available for processing on
MAXIS. Put in a DAIL/TIKL for April 1st to
determine QMB eligibility as May would then
be available on MAXIS.
SSI Recipient Turns 65
 Confirm on RMCR that Medicare participation
data has correctly interfaced from MAXIS to
MMIS:



Claim number
Part A participation dates
Part B participation dates
 If it has not, contact MMIS User Services to
complete the interface.
SSI Recipient Turns 65
 Enter QMB eligibility on RELG. This may be
completed no sooner than two months before
the effective date of the QMB eligibility.
 Review the RBUY and RBYB panels for
accretion request dates. These will display on
each panel after QMB has been approved
AND a buy-in accrete/delete processing has
occurred.
 Check MAXIS/MEC2/MMIS production region
calendar located in SIR for the dates.
SSI Recipient Turns 65
Examples:
 QMB was approved Mar 13 effective for
Apr 1. As this date is PRIOR TO March’s
accrete/delete processing date of 3/20,
RBUY/RBYB accrete request dates will
display on March 23.
 QMB was approved Mar 24 effective for
Apr 1. As this date is AFTER March’s
accrete/delete processing date of 3/20,
RBUY/RBYB accrete request dates will
display on April 22, after April’s accrete/delete
processing date of Apr 21.
SSI Recipient Turns 65
REMEMBER:
Enrollees who fail to cooperate with applying for
Medicare are ineligible for MA.
Cancel MA coverage with 10-day notice for enrollees
who fail to cooperate. Update PBEN disposition field
to “N – Not Applied Yet”
Additional Reference points:
 HCPM §03.35 Medicare Savings Programs
 HCPM §04.40 Medicare (and many subsections)
 TEMP §TE02.07.0326 Enrollment in Medicare Part A and Part B
 TEMP §TE02.07.0327 Medicare Part A/B and the Buy-in (Part 1)
 TEMP §TE02.07.0328 Medicare Part A/B and the Buy-in (Part 2)
 TEMP §TE02.13.40 RSDI/SSI Income Start Dates
 Instructional Bulletin 06-21-04 Medicare Part D Bulletin
Situation #6 Ansarra
Ansarra is a 70 year old LPR who entered the US 7
years ago. She was open on MA and QMB until
8/31/09 when she auto-closed for no Eligibility
Review. Her only income is SSI of $674.00 per
month. She came into the office today to reapply for
all Health Care programs. She is MA eligible 9/1/09.
Should this recipient Buy-in for Part A?
No Yes If yes what date? __________
Should this recipient Buy-in for Part B?
No Yes If yes what date? __________
Answer: Situation #6 Ansarra
Ansarra is a 70 year old LPR who entered the US 7
years ago. She was open on MA and QMB until
8/31/09 when she auto-closed for no Eligibility
Review. Her only income is SSI of $674.00 per
month. She came into the office today to reapply for
Health Care programs. She is MA eligible 9/1/09.
Should this recipient Buy-in for Part A?
Yes, 4/01/09.
Should this recipient Buy-in for Part B?
Yes, 11/01/09. For this kind of case there must be
an active Part A to be eligible for Part B.
Never The End
Contact MMIS User Services with
questions on specific cases.