01/03/00

  1. Qualified Medicare Beneficiary (QMB) Benefits
  2. Specified Low-Income Medicare Beneficiary (SLIB) Benefits
  3. Qualified Individuals (QI-1) Benefits

SMIB, HIB, QMB, SLIB, QI-1, and Renal codes appear on line 4 of the Item 60 coding field. If a person is eligible for any of these programs, the effective date of coverage is entered following the proper code. The correct status indicator (except for renal) follows the effective date of coverage.

Qualified Medicare Beneficiary (QMB) Benefits

If a client is QMB eligible, enter the correct status indicator code. The system centrally enters the 6-digit (month, day, year) effective date of QMB eligibility between Code QMB and the status indicator code. Enter the QMB effective date only if the approval decision is made on the last workday of the calendar month and the system is down.

Example: Eligibility for QMB benefits is determined on 10/31/98. The system is down and the approval action cannot be taken until November 1. Since eligibility was determined in October, the effective date of QMB eligibility is November 1, 1998. Enter 110198 following Code QMB.

Specified Low-Income Medicare Beneficiary (SLIB) Benefits

If a client is SLIB eligible, enter the correct status indicator code. Enter the SLIB effective date between the Code QMB and the status indicator. SLIB eligibility may be effective retroactive to 3 months before the month of the SLIB application.

Qualified Individuals (QI-1) Benefits

If a client is QI-1 eligible, enter the correct status indicator code. Enter the QI-1 effective date between the Code QMB and the status indicator. QI-1 eligibility may be effective retroactive to 3 months before the month of the QI-1 application.

MEDICARE-RELATED CODING
CODE STATUS INDICATOR DEFINITION
HIB 1 Entered centrally when Buy-in begins. Code 1 replaces Code 3 or 4.
HIB 2 Entered centrally or by the FCRC when person is potentially eligible for Medicare.
HIB 3 Entered by FCRC when HIB is verified and person is not in HIB Buy-in.
HIB 4 Entered centrally when BENDEX verifies HIB. Code 4 replaces Code 2 or 3.
SMIB 5 Entered by FCRC when SMIB is verified.
SMIB 6 Entered centrally when SMIB Buy-in begins. Code 6 replaces Code 5, 7, or 9.
SMIB 7 Entered centrally when SMIB is verified and person is not in SMIB Buy-in. Code 7 replaces Code 5 or 9.
SMIB 9 Entered by FCRC when potentially eligible person is referred to SSA to apply for Medicare.
QMB 1 Entered by FCRC when person is QMB and Medicaid.
QMB 2 Entered by FCRC when person is SLIB and Medicaid.
QMB 3 Entered by FCRC when person is QI-1 and Spenddown.
QMB 7 Entered by FCRC when person is QI-1 only.
QMB 8 Entered by FCRC when person is SLIB only.
QMB 9 Entered by FCRC when person is QMB only.
RNL - Date is centrally entered when person is eligible for Medicare due to Chronic Renal Disease.