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 WorksHow 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 WorksHow 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 FS1 C/D.

How Buy-In WorksHow 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 FS2 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 FS2 C/D.

How Buy-In WorksHow 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 FS1 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 WorksHow 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 WorksHow 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 WorksHow 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 FS1 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 FS2 C/D;

Set Tickler to confirm buy-in.

How Buy-In WorksHow 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 FS1 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 WorksHow 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.

How Buy-In WorksHow 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.

How Buy-In WorksHow Buy-In Works