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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
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 works2
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.

how buy in works3
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.
how buy in works4
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.
how buy in works5
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.
how buy in works6
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.

how buy in works7
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.
how buy in works8
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.
how buy in works9
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.
how buy in works10
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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