SI 04040.027: Processing the Prior Claim -- Title XVI Nondisability
Effective Dates: 11/28/2014 - Present
- TN 1 (02-02)
- SI 04040.027 Processing the Prior Claim -- Title XVI Nondisability
- A. Procedure -- prior claim favorable
- If the AC allows the prior claim, processing depends on the status of the subsequent claim.
- * Conduct a preeffectuation review contact (PERC) per SI 00603.030.
- * If the subsequent claim was allowed and there is no active claim iteration in MSSICS, follow the Automated One-Time-Payment (A-OTP) procedures in SM 01901.000 for the benefit payments due for the period prior to the new record. Issue a manual notice for the AC decision.
- * If the Subsequent claim was allowed and there is an active MSSICS iteration, check the filing date on the prior claim.
- If the filing date on the prior claim is NOT more than six years before the current month:
- * Open a Redetermination event in MSSICS.
- * Correct the EFFECTIVE FILING DATE in the SSI CLAIMS APPLICATION screen (ACLM) in MSSICS to match the filing date of the prior claim.
- * Develop and carefully complete the living arrangement, income, and resource screens to cover the EFFECTIVE FILING DATE of the prior claim through the date of the PERC on the subsequent application.
- Exception: If the PERC on the prior claim is conducted less than 90 days after the date the subsequent application was adjudicated AND the subsequent application was simultaneously developed, then limit the PERC period from the filing date of the first claim to the filing date of the subsequent claim.
- Follow instructions in MSOM MSSICS 008.003 and SM 01005.030 for EFFECTIVE FILING DATE.
- If the filing date on the prior claim is more than six years before the current date:
- * Complete paper forms (SSA-8000, SSA-8006, etc.) to document PERC per SI 00603.035 and SI 00603.036.
- * Manually compute any benefit payments for the prior period, and issue these payments following the Automated One-Time Payment (A-OTP) procedures in SM 01901.140. Issue the A-OTP.
- * Terminate (T33) the subsequent claim via Direct SSR Update and establish a new start date record via SSA-450SI with the correct Effective filing date and correct disability data.
- * Seed the case back in MSSICS.
- * If the subsequent claim is denied, it is considered a duplicate claim. If there is no active iteration on MSSICS, establish and process the prior claim through MSSICS if the effective filing date is no more than 6 years before the current date. If the prior claim is more than 6 years before the current date, T50 the subsequent claim on the SSR and establish and the prior claim via 450S systems procedures. Issue a manual notice for effectuation of the AC decision.
- B. Procedure -- prior claim unfavorable
If the AC issues an unfavorable decision or denies the request for review, it will retain the claims file for 150 days pending a possible civil action. If the folder is needed before the 150 days expires, direct requests to the appropriate ODAR location as shown on CICS (obtain an OHAQ). The folder is held either in the ODAR Megasite or the Disability Program Review Branch with jurisdiction over the case. The Megasite may be contacted by fax at (703) 274-0001. At the end of 150 days, the AC will return the claims file to the component that has the subsequent application.
x← This means that the line was removed and was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.