POMS Reference

HI 00930: Resolving Entitlement Problems

Compare the following items on the health insurance master and MBR replies and with the allegation: Date(s) of entitlement to HI and SMI and any termination information. Take the following action:

A. MBR and Allegation Agree

Refer the problem to BSS/HCFA. This is the proper action regardless of what the health insurance master shows.

B. MBR and Allegation Disagree

Obtain the necessary facts and refer them, together with the problem to the appropriate processing center (see HI 00930.050).

C. MBR-NIF

Obtain the necessary facts and refer to the appropriate processing center (see HI 00930.050).