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How Buy-In Works PowerPoint PPT Presentation


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How Buy-In Works. Automatic (If case is appropriately coded) : If client is receiving Medicare Part A when they apply. Contact Buy-in Unit: If client is eligible for but not receiving Medicare Part A. . How Buy-In Works. Process - Client Eligible For OHP Plus:

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How Buy-In Works

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How Buy-In Works

  • Automatic (If case is appropriately coded):

    • If client is receiving Medicare Part A when they apply.

  • Contact Buy-in Unit:

    • If client is eligible for but not receiving Medicare Part A.


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How Buy-In Works

  • Process - Client Eligible For OHP Plus:

    • Code all current OHP Plus eligibility (Usually OSIPM).

      • Receives Part A (no cost)/Receives Part B:

        • Code Case. No additional action required.

          Note: Set Tickler for disabled OSIPM clients receiving SSDI (mostly SSDI/SSI combo cases or SSDI Service cases), but have not met the 2 year SSDI requirement.


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How Buy-In Works

  • Process - Client Eligible For OHP Plus (Cont.):

    • Receives Part A (no cost)/No Part B:

      • If eligible for QMB-BAS:

        • Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS1 C/D;

          Note: No QMB Med Prg/#, No QMM C/D.

        • Wait for confirmation from Buy-in unit;

        • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMM C/D.


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How Buy-In Works

  • Process - Client Eligible For OHP Plus (Cont.):

    • Receives Part A (no cost)/No Part B (Cont):

      • If eligible for SMB/SMF:

        • Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS2 C/D;

          Note: No SMB/SMF Med Prg/#, No SMB/SMF C/D.

        • Wait for confirmation from Buy-in unit;

        • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SMB/SMF Med Prg/#, SMB/SMF C/D.

      • All other OHP Plus (SBI):

        • Code with MIB 2 (Medicare A & D in Health Ins. tab of ACCESS) & FS2 C/D;

        • Wait for confirmation from Buy-in unit;

        • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SBI C/D.


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How Buy-In Works

  • Process - Client Eligible For OHP Plus (Cont.):

    • No Part A/ Receives Part B:

      • If Otherwise eligible for QMB-BAS:

        • Code with MIB 1 (Medicare B & D in Health Ins. tab of ACCESS) & FS1 C/D;

          Note: No QMB Med Prg/#, No QMM C/D.

        • Contact Buy-in Unit for Part A, wait for response;

        • Once confirmed: Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMM C/D.

      • All other OHP Plus (SBI):

        • Code with MIB 1 (Medicare B & D in Health Ins. tab of ACCESS), FS2 & SBI C/D.


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How Buy-In Works

  • Process - Client Eligible For OHP Plus (Cont.):

    • No Part A/No Part B

      • Complete DHS 1460B and give to client:

        • Client needs to take form to local SSA office to sign up for Medicare;

        • SSA will then contact Buy-In unit;

        • Once the Buy-In unit has set up for buy-in, and buy-in has processed, they will contact worker to code for QMB-BAS, QMB-SMB/SMF or SBI;

          Note: SSA normally contacts the buy-in unit very quickly (sometimes same day) when they receive a 1460B from our client. Staff should set Tickler for 2 weeks to follow-up with the Buy-In unit.


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How Buy-In Works

  • Process - Client Not Eligible For OHP Plus:

    • Receives Part A (no cost)/ Receives Part B.

      • Code Case. No additional action required.


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How Buy-In Works

  • Process - Client Not Eligible For OHP Plus (Cont.):

    • Receives Part A (no cost) / No Part B:

      • If Otherwise eligible for QMB-BAS:

        • Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMB C/D;

        • Set Tickler to confirm buy-in.

      • If Otherwise eligible for QMB-SMB/SMF:

        • Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), SMB/SMF Med Prg/#, SMB/SMF C/D;

        • Set Tickler to confirm buy-in.


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How Buy-In Works

  • Process - Client Not Eligible For OHP Plus (Cont.):

    • No Part A / Receives Part B:

      • If Otherwise eligible for QMB-BAS:

        • Code with MIB 3 (Medicare A & B & D in Health Ins. tab of ACCESS), QMB Med Prg/#, QMB C/D. Open case effective 1st day of following month;

        • Contact Buy-in unit for Part A;

        • Set Tickler to confirm buy-in.


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How Buy-In Works

  • Process - Client Not Eligible For OHP Plus (Cont.):

    • No Part A / No Part B:

      • If Otherwise eligible for QMB-BAS:

        • Complete DHS 1460B and give to client;

        • Client needs to take form to local SSA office to sign up for Medicare Part B;

        • Set up pended case and narrate;

        • SSA will then Contact Buy-In unit;

        • Set Tickler to confirm Part B buy-in;

        • Once the Buy-In unit has set up for Part B buy-in, and it has processed, they will contact worker;

        • Once Part B buy-in confirmed proceed as “No Part A / Receives Part B” from previous slide.


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How Buy-In Works

  • Retroactive Buy-In (SMB/SMF):

    • For P2 clients only.

      • Determine eligibility month-by-month for retro.

      • Code as normal (can go back to first of previous month on CM).

      • Send 148 for remainder.

      • Contact Buy-In unit with retro dates.


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