WAG 22-06-07: Payment of Claims

PM 22-06-07.

The FCRC checks submitted claims for:

  • meeting time limits,
  • providing required documentation,
  • correct charges and other payment sources, and
  • accuracy and legibility of signature, claimant information, client information (case name and number) and all other entries on all copies of the claim form.

When a claim is approved for payment:

  1. Obtain a copy of HFS 552 showing the cancellation of the deceased's case or removal from the case. If a HFS 552 is not available, use a terminal printout showing CIS screens 1, 2, and 3 - name, needs, and people.
  2. Complete HFS 1619, Funeral and Burial Claim Report. The HFS 1619 serves as the transmittal cover for routing the claim forms, the appropriate documentation, the HFS 552, and the HFS 1959, Funeral/Burial Payment Request Notice. Sign #7, the local office recommended disposition.
  3. Send information to the Funeral and Burial Unit, Springfield.

When a claim cannot be paid as submitted but can be adjusted:

  1. Adjust the claim.
  2. Use HFS 1959 to notify the claimant of the adjustment.
  3. Attach a copy of HFS 1959 to the claim.
  4. Process the adjusted claim for payment.

When a claim cannot be paid because it is incorrect or incomplete:

  1. Complete HFS 1959 to explain the problem and suggest corrections.
  2. Return claim and HFS 1959 to the claimant.
  3. Process resubmitted claim for payment with a copy of HFS 1959 attached.

When vendor charges are more than the maximum amount allowed:

  1. Return the claim to the claimant pointing out the certification statement and the instructions on the back of the claim form.
  2. Tell the funeral home that a reimbursement claim is appropriate.
  3. Tell the vendor if they resubmit the claim it must have a separate statement from the funeral director certifying that the total charge has been reduced to the Department's allowance.

When a request/claim for payment of funeral/burial expenses is denied:

  1. Complete 3 copies HFS 1959, Funeral/Burial Payment Request Notice.
    1. Enter the reason for denial of the request or claim.
  2. Send the original HFS 1959 to the person requesting payment.
    1. Send a copy to the Funeral and Burial Unit, Springfield.
    2. File the 2nd copy in the case record.