WAG 06-12-03-a: Central Approval

PM 06-12-03-a

BENDEX verifies Medicare Part A enrollment.

1. (System) Enters with code 4 in Item 60 of Form 552 following code HIB.
   1. Enters effective date (month/year) of QMB eligibility following code QMB, as well as code 1, in Item 60 when:
      • HIB enrollment is centrally verified and coded; and
      • the Medicare or Railroad Retirement claim number appears in Item 60; and
      • case is approved as Cash or Regular Medical; or
      • the case has:
        • code 390 SPD, code 391 SPDGC, or code 395 GCARE in Item 80; or
        • the amount following Item 80 code 392 does not exceed $2,000; and
        • income amounts applying to the Medicaid case in Item 90 total the amount equal to or less than $25 plus the QMB income limit for a single person.
2. (System) Converts the following cases if Item 90 income codes that apply to the Medicaid case total the amount equal to or less than $25 plus the QMB income limit for a single person:
   • sheltered care cash cases (Code 13 in Item 20);
   • cases in zero grant status because they would still be eligible for cash except for the Social Security benefit increase of 1977, 1978, 1979, 1980, and/or 1981 (Code 6 in Item 34);
   • persons in homes not subject to licensing (Code 14 in Item 20); and
   • long term care cases (Code 15 in Item 20).
3. (System) Mails Notice Regarding Medicare Cost Sharing (Form 3132) to clients who are centrally approved for QMB.