TN 12 (04-00)

A. PROCEDURE - MEDICARE CONTRACTOR'S CHECKS

Send all returned Medicare contractor's checks issued by the intermediary or carrier such as Blue Cross/Blue Shield, Aetna, Traveler's, etc., to the intermediary or carrier who issued the check.

Forward Medicare overpayment refunds not involving premium payments to the intermediary or carrier shown on the notice of overpayment unless the refund is submitted in response to an action generated by the PC. In those situations, forward the refund to the MATPSC.

B. PROCEDURE - MEDICARE CONTRACTORS CHECKS

Handle returned Medicare contractor's checks received in the FO as follows.

1. Interviewer

1. Stamp the returned check “NOT NEGOTIABLE”.

   The check may already be stamped “NOT NEGOTIABLE” by the mailroom or reception area personnel. See GN 02403.004.

2. Enter the remittance into the system, using Trust Fund code “N” , and Reason code “Q”. Give the automated receipt to the remitter. Give remittance to remittance clerk. In addition to the receipt, DMS will also generate a forwarding instruction sheet indicating how the remittance should be handled.

3. Give the remittance to the Remittance Clerk

   REFERENCE: See MSOM DMS 003.006 and MSOM DMS 003.007 for how to obtain automated FO receipt.

2. Remittance Clerk

1. At the end of day, obtain FO Daily Receipt Listing and associate remittance with remittance.

   REFERENCE: See MSOM DMS 004.009 for how to obtain FO Daily Receipt Listing.

   Form SSA-414-U3 will not be prepared and FO Remittance Transmittal will not be sent for returned Medicare contractor's checks since the contractor is not required to acknowledge their receipt.

2. Hand carry the check(s) and FODRL to the Remittance Supervisor.

3. Remittance Supervisor

1. Verify and reconcile all remittances for which receipts were issued that day, and sign and date the FODRL if it is in agreement with the listed remittances.

2. Compare the check to any mailroom and reception area logs completed that day. Ensure that any returned Medicare contractor's check logged in that day has been stamped “NOT NEGOTIABLE” and a receipt was issued.

3. Mail returned Medicare contractor's checks daily to the issuing carrier or intermediary address as listed in the Intermediary Manual.

C. PROCEDURE - MEDICARE OVERPAYMENT REFUNDS

Process Medicare overpayment refunds not involving premium payments received in the FO, as follows.

1. Interviewer

1. Is refund received in cash?

   • If yes, follow procedure in GN 02403.009, Processing Cash Remittances Received in the FO. STOP.

   • If no, see GN 02403.040C.1.b.

2. Enter the remittance into the system for an automated FO Receipt. Use Trust Fund code “N” and Reason code “D”. Give the receipt to the remitter. In addition to the receipt, DMS will also generate a forwarding instruction sheet indicating how the remittance should be handled.

   REFERENCE: See MSOM DMS 003.006 and MSOM DMS 003.007 for how to obtain FO Receipt.

3. Give remittance to the remittance clerk.

2. Remittance Clerk

1. At the end of day, obtain FODRL and associate the remittance to it.

   REFERENCE: See MSOM DMS 004.009 for how to obtain FODRL.

2. Hand carry FO Daily Receipt Listing with related payment coupons and refund payments to the remittance supervisor at the end of the day.

3. Remittance Supervisor

1. Compare the refund to any mailroom and reception area logs completed that day. Ensure that any Medicare overpayment refunds logged in that day are on FODRL.

2. Record any discrepancies and resolve them with the remittance clerk/interviewer

3. If the refund is:

   • received with notice from the intermediary or carrier, forward refund to the intermediary or carrier shown on the notice of the overpayment.

   • submitted in response to an action generated by the PSC, forward the refund to the MATPSC, along with other remittances that are listed on the FORT.

     The Medicare overpayment refund will not be listed on the FORT but will be included on the FODRL.

   • received and does not show the identity of the overpaid party or of the carrier or intermediary which made the overpayment, forward the refund with as much information as is available to the CMS Regional Office at the appropriate address listed in GN 02403.040D. based upon the overpaid party's address using GN 02403.040E.

D. LIST OF CMS REGIONAL OFFICES

All correspondence is mailed to CMS Regional Offices at the appropriate address below.

Northeast Consortium

Region 1--Boston

Region 2--New York

Region 3--Philadelphia

Consortium Administrator--New York RA

Southern Consortium

Region 4--Atlanta

Region 6 Dallas

Consortium Administrator

Atlanta RA

Midwest Consortium

Region 5--Chicago

Region 7--Kansas City

Consortium Administrator--KC RA

Western Consortium

Region 8--Denver

Region 9--San Francisco

Region 10--Seattle

Consortium Administrator--Denver RA

E. LIST OF STATES IN CMS REGIONS

The States in each CMS region are listed below.