GN 01702: DO Development and Routing of Totalization Claims
TN 2 (03-04)
A. Introduction
Totalization coding is used to generate notice language in claims for U.S. benefits (Totalization or nonTotalization) and to produce an earnings record to be sent to the foreign country with a claim for foreign benefits. In addition, since entitlement to a Totalization benefit cannot establish entitlement to premium-free hospital insurance (HI) under Medicare (see GN 01701.140), the presence of some codes prevents automatic HI enrollment. The Social Security Administration has developed a series of Totalization codes to indicate on the Master Beneficiary Record (MBR) the status of a claim for U.S. Totalization benefits and the name of the agreement country involved.
B. Process
Totalization codes are posted to the MBR only when there is a claim for U.S. Totalization benefits. The coding is systems generated based on entries on the modernized claims system (MCS) screens. Claims for benefits from a foreign country do not generate any codes or indicators. However, the Office of International Operations (OIO) will annotate the Modernized Development Worksheet (MDW) screen when a claim for benefits is forwarded to the foreign country.
C. Definitions
1. Totalization Status Codes (TSC)
TSCs are two digit codes that describe the status of a claim for U.S. Totalization benefits. The different codes are defined below.
a. Award Codes
| Codes | Definition |
|---|---|
| A1 | Number holder (NH) is insured only by combining U.S. and foreign coverage. |
| A3 | NH is insured only by combining U.S. and foreign coverage and the beneficiary is entitled to premium-free HI as a Medicare Qualified Government Employee or an End Stage Renal Disease beneficiary. |
| E2 |
NH was initially insured only by combining U.S. and foreign coverage, subsequently acquired enough additional U.S. credits to be insured based on U.S. coverage alone but continues entitlement to Totalization benefits because they are greater (see GN 01701.305B.1.). |
b. Denial codes
| Codes | Definition |
|---|---|
| D1 |
NH has fewer than 6 quarters of coverage (QCs) (see GN 01701.110) |
| D2 |
NH has at least 6 QCs but is not insured even after counting foreign coverage. |
| D3 |
NH is insured based on U.S. coverage alone. |
| D4 |
NH is insured based on U.S. coverage alone or by combining U.S. and foreign coverage but does not meet another entitlement factor (e.g., age). |
c. Claim pending codes
| Codes | Definition |
|---|---|
| P1 |
NH has at least 6 QCs but is not insured and the claim cannot be adjudicated until the foreign coverage record is received. |
| P2 |
A nonTotalization claim has been awarded but Totalization may yield an earlier month of entitlement or disability insured status. |
d. Termination codes
| Code | Definition |
|---|---|
| T1 |
Totalization benefits have terminated because the beneficiary became entitled to higher nonTotalization benefits. |
2. Totalization Country Codes (TCC)
TCCs are 5 character alpha codes that identify, by country, the agreement under which a claim for U.S. Totalization benefits has been filed. Where an applicant has filed under more than one agreement, only one code will be shown. These codes are defined below.
| Name of Country | TCC Code |
|---|---|
|
Australia |
AUSSI |
|
Austria |
AUSTR |
|
Belgium |
BELGI |
|
Canada |
CANAD |
|
Chile |
CHILE |
|
Czech Republic |
CZECH |
|
Denmark |
DENMK |
|
Finland |
FINLA |
|
France |
FRANC |
|
Germany |
GERMA |
|
Greece |
GREEK |
|
Ireland |
IRELA |
|
Italy |
ITALY |
|
Japan |
JAPAN |
|
Korea (South) |
KOREA |
|
Luxembourg |
LUXEM |
|
Netherlands |
NETHE |
| Norway | NORWA |
|
Poland |
POLND |
|
Portugal |
PORTU |
Slovak Republic |
SLOVA |
|
Spain |
SPAIN |
| Sweden | SWEDE |
| Switzerland | SWISS |
| United Kingdom | UKING |