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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 Works. Process - Client Eligible For OHP Plus:

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How Buy-In Works

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  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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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