TN 6 (11-09)

A. Background

This section defines component responsibility for processing requests for non-medical reconsiderations under Title II and reconsiderations under Title XVIII of the Social Security Act.

See Also

Appeal policies and procedures specific to a particular benefit are in the following references:

• SI 04020.020, Request for SSI Reconsideration.

• HI 03040.001, Appeal Process for Medicare Part D.

• VB 02502.001, The Reconsideration Process.

B. Policy for jurisdiction and component responsibility

1. Field Office (FO)

The FO is responsible for:

1. Explaining the reconsideration process.

2. Interviewing and assisting the claimant in filing the request for reconsideration.

3. Establishing the reconsideration on MCS for claims that are not MCS exclusions (see GN 03102.500 and MSOM MCS 004.002). The writing and document may be attached to the claims folder copy of the appeal form, for paper appeals see GN 03102.100.

4. Processing to completion the following kinds of reconsiderations:

   • Insured status denials of disability claims DI 12005.010D.

   • Res judicata denial DI 27516.001C.

   • Work CDR determinations DI 13010.145.

   • Initial denials for substantial gainful activity DI 12005.010C.

   • Representative payee issues such as capability (GN 00503.120D), misuse case — negligence and overpayment determinations (GN 00604.010), and payee selection (GN 00503.120E).

   • Medicare State Buy-in issues HI 00815.085E.

   • IRMAA appeals HI 01140.005.

   • Administrative sanctions GN 02604.435.

2. Processing Center (PC)

The PC is responsible for processing all other non-medical reconsideration requests not listed in GN 03102.175B.1.d. for the following:

• RSI claims;

• Medicare entitlement under Title XVIII;

• DIB claims (age 54 and older);

• DWB claims (age 54 and older);

• CDB claims filed on a RIB account and CDB claims filed on a DIB account age 54 and older;

• DWB claims disallowed for non-medical reasons;

• Overpayments;

• Waivers;

• Post-entitlement issues.

NOTE: PCs are responsible for processing IRMAA reconsideration requests received directly from beneficiaries and requests transferred from the FO to the PC. When a PC receives a case from the FO, the PC determines if a manual action is required due to a processing limitation such as LESSDO. If no action has been taken by the FO and it appears the case was transferred in error, process the request and contact the FO to direct them to the instructions contained in HI 01140.005.

The PC receives reconsideration referrals from the field office through the Detailed Office and Organization Resource System (DOORS).

3. Great Lakes Program Service Center (GLPSC)

The GLPSC Disability Processing Branch processes reconsideration requests on career Railroad Retirement Board (RRB) disability cases (see DI 12045.065 and DI 11010.262).

4. Office of Disability Operations (ODO)

ODO reconsiders:

• Non-medical issues on disability claims when the number holder (NH) is under age 54.

• Non-medical issues on disability claims not specified as PC 1 through 6 jurisdictions.

• Medicare Part A and Part B entitlement determinations relating to chronic renal disease.

5. Office of Earnings Operations (OEO)

OEO reconsiders earnings discrepancies forwarded by the FO or PC. For information about other components that may process reconsideration requests for earnings discrepancies see RS 01405.005B.2.

6. Disability Determination Service (DDS)

DDS reconsiders medical determinations on initial claims (see DI 20101.010 and DI 12005.010), with the exception of Prototype States, where the first level of appeal is the hearing and not the reconsideration see DI 12015.100B and DI 12015.100D.

The DDS Disability Hearing Unit (DHU) reconsiders medical cessations see DI 33000.000.

7. Office of International Operations (OIO)

OIO primarily serves claimants and beneficiaries residing outside the United States and processes reconsiderations in those instances. However, some claimants with Canadian addresses are serviced by field offices on the northern border of the U.S. See Identification of Designated Border Offices GN 01715.320.

8. Subsidy Appeals Unit (SAU)

The appeal process for the Medicare Part D Subsidy determination does not include a reconsideration level of appeal. Instead, the appeal process for subsidy determinations consists of one formal SSA administrative step. The individual can choose a hearing by telephone or a case review. See Overview of Appeal Process for Medicare Part D Subsidy Determination HI 03040.001.