GN 01050: Assembly, Jurisdiction and Routing of Claims
TN 3 (09-17)
This section provides information about determining Processing Center (PC) jurisdiction and routing of claims, including internet claims (iClaims). We organized the routing information in chart format by claim type (Non-Disability, Disability, and iClaims.) Claims situations not covered by these instructions include cases involving:
more than two PCs, or
dual and triple entitlement.
Employees should use their best judgment to route claims not covered by these instructions, and document the decision on a report of contact (RC). If the PC receives a misrouted claim, the receiving PC adjudicates it and processes it completely.
Route a cross-referred Beneficiary Identification Code (BIC) “T” or “M” claim on Social Security Numbers (SSN) serviced by different PCs to its own PC, accompanied by an RC regarding the other claim.
A. PC Name/SSN Area Number Range/PC Claims Jurisdiction
Use this chart as a guide to determine PC jurisdiction of a claim. In most instances, determine PC jurisdiction by SSN area number (the first three digits of an SSN.) However, in some instances, determine PC jurisdiction by the type of claim as indicated in the column labelled ‘PC Claims Jurisdiction.’
In these cases, the claim type supersedes the SSN area number when determining PC jurisdiction:
|
PC Name |
SSN Area Number Range |
PC Claims Jurisdiction |
|---|---|---|
|
PC1 |
000-134, 729, 805-808 |
Environmental Health Hazards (EHH) Medicare claims |
|
PC2 |
135-222, 232-236, |
|
|
PC3 |
223-231, 237-267, |
|
|
PC4 |
268-302, 316-399, |
|
|
PC5 |
501-504, 516-524, |
|
|
PC6 |
303-315, 429-500, |
|
|
PC7 |
N/A |
DIB claims (age less than 54), and End Stage Renal Disease (ESRD) Medicare claims. |
|
PC8 |
N/A |
Foreign Claims |
B. Non-disability claims routing
Use this chart as a guide to determine where to route all non-disability claims:
|
Situations |
Routing |
Remarks |
|---|---|---|
|
1. INITIAL CLAIMS (No Prior Claim Filed) |
PC with jurisdiction of the SSN area number. |
EXCEPTIONS: Foreign involvement (see GN 01050.075B.3. in this chart); Cross-Reference multiple folder involvement (see GN 01050.075B.5. in this chart); and Disability involvement (see GN 01050.075C in this section). |
|
2. SUBSEQUENT CLAIMS |
PC with jurisdiction of the SSN area number. |
EXCEPTIONS: Disability involvement (see GN 01050.075C. in this section); Foreign involvement (see GN 01050.075B.3. in this chart); Survivor involvement see GN 01050.075B.8.a. and GN 01050.075B.8.b. in this chart. |
3. FOREIGN INVOLVEMENT |
OEIO |
Applicable: if any claimant resides outside of the *U.S.; or if any claimant uses a mailing address outside the *U.S.; or if any claimant has been, or will be, outside the *U.S. for more than 6 months. *“U.S.” includes all 50 States, the District of Columbia, American Samoa, Guam, Puerto Rico, the Northern Mariana Islands (NMI), and the U.S. Virgin Islands. |
4. TOTALIZATION CLAIMS |
See Routing of Claims for U.S. Benefits Involving Totalization in GN 01702.310; and Routing of Claims for U.S. Totalization Disability Benefits in GN 01702.410. |
|
|
5. MULTIPLE FOLDERS (Multiple Claims) X-Reference with STAT code “R”, “P”, or BIC |
If there is disability involvement, see GN 01050.075C in this section. |
|
a. Initial Claims on each SSN |
Route each claim to the PC with jurisdiction of the SSN area number (with the exception of disability and foreign.) |
|
b. Initial Claim for one NH; subsequent claim under another NH’s SSN |
Route each claim to the PC with jurisdiction of the SSN area number (with the exception of disability and foreign.) |
|
c. Retirement Insurance Benefits (RIB) entitlement only |
PC with jurisdiction of the SSN area number, or of each SSN area number (when there is more than one). |
|
6. All other claim types not mentioned in other sections |
PC with jurisdiction of the SSN area number. |
EXCEPTIONS: Foreign involvement (see GN 01050.075B.3. in this chart); Cross-Reference multiple folder involvement (see GN 01050.075B.5. in this chart); and Disability involvement (see GN 01050.075C in this section). |
7. Lump-sum only claims |
PC with jurisdiction of the SSN area number. |
|
8. Subsequent claims; except |
PC with jurisdiction of the SSN area number. |
|
|
a. Survivor claim filed when disabled primary claimant (HA) dies |
PC other than ODO with jurisdiction of the decedent’s SSN area number. |
|
b. Sole survivor claim filed by RIB beneficiary |
PC with jurisdiction of decedent’s SSN area number. |
C. Disability claims routing
Use this chart as a guide to determine where to route all disability claims. Route claims with disability involvement to the Disability Determination Services (DDS), ODO, or if “foreign,” OEIO, per instructions in the chart. For age 54 Disability Insurance Benefits (DIB) claims, refer to DI 11010.280.
|
Situations |
Pre-Adjudicative Routing |
Adjudication |
Post-Adjudicative Routing |
|---|---|---|---|
|
DDS Jurisdiction for Disability Determination |
to DDS per DI 11010.255 |
||
|
Allowance |
to resident field office (FO) per |
FO (except adverse claim or appeal pending at ODO. |
to ODO |
|
Denial |
to resident FO per DI 32005.001 through |
FO |
Retain in FO per DI 11010.370. |
|
SSA Jurisdiction for Disability Determination |
to ODO per |
ODO |
|
|
Technical Denials |
FO |
Retain in FO per DI 11010.370. |
|
|
Other Claims; No Disability Determination |
FO (except adverse claim or appeal pending in ODO) |
to ODO per |
|
|
Foreign Address |
to OEIO |
OEIO |
to OEIO. |
|
Career Railroad |
to GLPSC |
GLPSC |
to GLPSC. |
|
DIB-RSI claim |
See DI 11010.300 |
||
|
DIB auxiliary claim |
PC which has the Wage Earner’s (WE’s) disability file (ODO, PC, or OEIO). |
NOTE: If technical entitlement is established on one SSN, but payment will be made on another SSN, see GN 01050.060E.
D. Internet claims (iClaims) routing
Use this chart as a guide to determine where to route all iClaims:
|
Situations |
Pre-Adjudicative Routing |
Adjudication |
Post-Adjudicative Routing |
|---|---|---|---|
|
Spanish iClaims |
Jurisdictional FO. NOTE: Spanish iClaims are WSU exclusions. iClaim automatically routes Spanish iClaims to the jurisdictional FO. |
Jurisdictional FO. |
PC with jurisdiction of the SSN area number. |
|
iClaims with domestic residence address. |
Jurisdictional FO or WSU based on terminal digits of NH’s SSN. NOTE: iClaim automatically routes claims with all of the following characteristics to the jurisdictional FO or WSU based on terminal digits: Claim is for RIB or Medicare-only; Claim is submitted in English; Claimant provides a domestic residence address; and Established proof of claimant’s age and citizenship. iClaim automatically routes the following claims with domestic addresses to the jurisdictional FO only: RIB and Medicare-only applications where the claimant’s age or citizenship status has not been proven; all DIB and DIB/RIB claims; and all Spanish iClaims. |
Jurisdictional FO or WSU based on terminal digits of NH’s SSN. |
PC with jurisdiction of the SSN area number. |
|
iClaims with foreign residence address |
OEIO NOTE: All Canadian iClaims will route to the servicing FO based on the first three characters of the postal code. Canadian iClaims with no postal code will route to OEIO. All other foreign claims will route to OEIO. Claims with APO, FPO, or DPO addresses will route to OEIO. |
OEIO |
OEIO |