NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 1104

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BENEFICIARY EXCHANGE (BENDEX)

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EIS 1104 – BENEFICIARY EXCHANGE (BENDEX)


I. GENERAL INFORMATION

II. BENDEX PROCESSING

III. BENDEX INFORMATION SHEET

IV. OnLine Verification System Information:

IV. D. HIB Entitlement (Part A)

IV. E. SMI (Supplemental Medical Insurance) Entitlement (PartB)

IV. F. Payment History

IV. G. Logoff Procedures

V. USE OF FORMS

VI. MESSAGE LIST

VII. DEFINITION LISTING

VIII. SSA SYSTEMS INTERFACE IDENTIFICATION CODES


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EIS 1104 – BENEFICIARY EXCHANGE (BENDEX)

REVISED 03/01/07 - CHANGE NO. 05-07

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I. GENERAL INFORMATION

A. Timely adjustment of assistance after a reported change in RSDI benefits.

B. Reduction in processing time due to less frequent use of the SSA-1610 (Information Request and Report) and DSS-1639 (Assistance and Services Referral Form).

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II. BENDEX PROCESSING

A. When an individual becomes eligible for public assistance:

B. On-line BENDEX is updated, and a BENDEX information screen is produced when one of the following occurs:

REVISED 03/01/07 - CHANGE NO. 05-07

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III. BENDEX INFORMATION SHEET

A. BENDEX Data Exchange Information Sheet County Information

REVISED 03/01/07 - CHANGE NO. 05-07

III. (CONT’D)

B. CNDS Demographic Details

C. SSA Demographic Details

REVISED 03/01/07 - CHANGE NO. 05-07

III. C. (CONT’D)

REVISED 03/01/07 - CHANGE NO. 05-07

III. C. 15. (CONT’D)

REVISED 03/01/07 - CHANGE NO. 05-07

III. C. (CONT’D)

D. Claim Information

 

Adjustment:

AD

Adjusted for dual-entitlement.

 

AS

Adjusted for simultaneous entitlement.

 

A9

All other adjustment actions.

       
 

Current Payment:

CP

Current Payment Status Code.

       
 

RRB Involvement:

E

RRB paying benefits.

       

REVISED 03/01/07 - CHANGE NO. 05-07

III. D.6. (CONT’D)

 

Current Payment:

CA

Claim has been adjudicated; Entitlement is a future date.

 

Advanced Filing Deferred:

DP

Receipt of public assistance.

 

DW

Receipt of worker’s compensation.

 

D1

Engaging in foreign work.

   

D2

Beneficiary overpaid because of work.

   

D3

Auxiliary’s benefits withheld because of D2 status for primary beneficiary.

   

D4

Failure to have child in care.

   

D5

Auxiliary’s benefits withheld because of a D1 status for primary beneficiary.

   

D6

Deferred to recover overpayment for reason not attributable to earnings.

   

D9

Miscellaneous deferment.

       
 

Denied:

N

Disallowed claim.

   

ND

Disability claim denied.

       
 

Delayed:

K

Advanced filing for deferred payment.

   

L

Advanced filing.

   

P

Adjudication pending.

   

PB

Benefits delayed, due but not paid.

   

PT

Claim terminated from delayed status.

   

R

Kill Credit (deletes payment record).

       
 

Suspended:

S0

Determination of continuing disability is pending.

   

S1

Beneficiary engaged in work outside the U.S.

   

S2

Beneficiary is working in the U.S. and expects to earn in excess of annual allowable limit.

   

S3

Auxiliary’s benefits withheld because of S2 status of primary beneficiary.

   

S4

Failure to have child in care.

   

S5

Auxiliary’s benefits withheld due to S1 status for primary beneficiary.

   

S6

Check was returned – correct address being developed.

   

S7

Disabled beneficiary suspended due to refusal of vocational rehabilitation; imprisoned; extended trial work period.

   

S8

Suspended while payee is being determined.

   

S9

Suspended for reason not separately defined.

REVISED 03/01/07 - CHANGE NO. 05-07

III. D.6. (CONT’D)

   

SD

Technical entitlement only. Beneficiary is entitled on another claim.

   

SF

Special age 72 beneficiary fails to meet residency requirement.

   

SH

Special age 72 beneficiary is receiving a Government pension.

   

SJ

Alien suspension.

   

SK

Beneficiary has been deported.

   

SL

Beneficiary resides in a country to which checks cannot be sent.

   

SM

Beneficiary refused cash benefits (entitled to HI-SMI only).

   

SP

Special age 72 beneficiary suspended due to receiving public assistance.

   

SS

Post secondary student summer suspension.

   

SW

Suspended because of worker’s compensation.

       
 

Terminated:

TA

Terminated prior to entitlement.

   

TB

Mother, father terminated because beneficiary is entitled to disabled widow(er)’s benefits.

   

TC

Disabled widow attained age 62 and is not entitled as an aged widow.

   

TJ

Advanced – filed claim terminated after maturity.

   

TL

Termination of post secondary student.

   

TP

Terminated because of change in type of benefit or post-entitlement action.

   

T

Converted from disability benefits to retirement benefits upon reaching age 65.

   

T0

Benefits are payable by some other agency.

   

T1

Terminated due to death of the beneficiary.

   

T2

Auxiliary terminated due to death of the primary.

   

T3

Terminated due to divorce, marriage or remarriage of the beneficiary.

   

T4

Child attained age 18 or 22 and is not disabled; mother/father terminated because last child attained age 18.

   

T5

Beneficiary entitled to other benefits equal or larger.

REVISED 03/01/07 - CHANGE NO. 05-07

III. D.6. (CONT’D)

 

Terminated:

T6

Child is no longer a student or disabled; or the last entitled child died or married.

   

T7

Child beneficiary was adopted.

   

T8

Primary beneficiary no longer disabled or the last disabled child no longer disabled.

   

T9

Terminated for reason not separately defined.

       
 

Uninsured:

U

Beneficiary is entitled only to HI or SMI.

       
 

Withdrawal

W

Withdrawal before entitlement.

       
 

Other adjustment or termination status:

X0

Claim transferred to RRB.

   

X1

Beneficiary died.

   

X5

Entitled to other benefits.

   

X7

HIB/SMI terminated.

   

X8

Payee is being developed.

   

X9

Terminated for reason not separately defined.

   

XD

Withdrawn for adjustment.

   

XK

Deportation.

   

XR

Withdraw from SMI.

REVISED 03/01/07 - CHANGE NO. 05-07

III. D. (CONT’D)

REVISED 03/01/07 - CHANGE NO. 05-07

III. D. (CONT’D)

E. Health Insurance Benefit (HIB-Part A)

REVISED 03/01/07 - CHANGE NO. 05-07

III. E. (CONT’D)

REVISED 03/01/07 - CHANGE NO. 05-07

III. E. (CONT’D)

F. Supplemental Medical Insurance Entitlement (SMI-Part B)

REVISED 03/01/07 - CHANGE NO. 05-07

III. F. (CONT’D)

REVISED 08/01/11 - CHANGE NO. 01-12

III. F. (CONT’D)

G. Claim Payment History

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IV. OnLine Verification System Information:

BENDEX Data Exchange Screens show the following information:

REVISED 08/01/11 - CHANGE NO. 01-12

IV. (CONT’D)

A. Recipient Demographic

RECIPIENT Demographic

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IV. (CONT’D)

B. Recipients Details

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IV. B. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

IV.B.17. CONT’D

C. Claim Information

Claim ID :

123456789D6

Direct Deposit Type :

Checking

Process Date :

5/1/2011

Current Payment Amount :

$695.00

Modification Date :

4/11/2011

Gross Amount Payable :

$695.10

Previous Modification Date :

3/4/2011

Monthly Net Benefit Amount :

$695.00

Pay status :

Cp - Current Payment

Monthly Retroactive Payment Amount :

$0.00

Bendex Status :

Agency Conflict - Individual Was Moved From Hawaii To Nc

Monthly Garnishment Amount :

$0.00

Welfare Agency :

North Carolina

SSI Overpayment Amount :

$0.00

Initial Entitlement Date :

6/1/1972

Medicare Premium Deduction :

Inactive

Current Entitlement Date :

1/1/2001

Monthly Overpayment Deduction Amount :

$0.00

Deferred Payment Date :

 

Overpayment Deduction End Date :

 

Payment Cycle :

Third Of The Month

Payment Effective Date :

11/2010

Payee Information

Netta Della

 

3 Queen Rd.

 

RALEIGH NC

 

99999

   

REVISED 08/01/11 – CHANGE NO. 01-12

IV.C. CONT’D

 

Adjustment:

AD

Adjusted for dual-entitlement.

 

AS

Adjusted for simultaneous entitlement.

 

A9

All other adjustment actions.

       
 

Current Payment:

CP

Current Payment Status Code.

       
 

RRB Involvement:

E

RRB paying benefits.

       
 

Current Payment:

CA

Claim has been adjudicated; Entitlement is a future date.

Advanced Filing Deferred:

DP

Receipt of public assistance.

 

DW

Receipt of worker’s compensation.

 

D1

Engaging in foreign work.

   

D2

Beneficiary overpaid because of work.

   

D3

Auxiliary’s benefits withheld because of D2 status for primary beneficiary.

   

D4

Failure to have child in care.

REVISED 08/01/11 – CHANGE NO. 01-12

IV.C.5. CONT’D

   

D5

Auxiliary’s benefits withheld because of a D1 status for primary beneficiary.

   

D6

Deferred to recover overpayment for reason not attributable to earnings.

   

D9

Miscellaneous deferment.

 

Denied:

N

Disallowed claim.

   

ND

Disability claim denied.

 

Delayed:

K

Advanced filing for deferred payment.

   

L

Advanced filing.

   

P

Adjudication pending.

   

PB

Benefits delayed, due but not paid.

   

PT

Claim terminated from delayed status.

   

R

Kill Credit (deletes payment record).

 

Suspended:

S0

Determination of continuing disability is pending.

   

S1

Beneficiary engaged in work outside the U.S.

   

S2

Beneficiary is working in the U.S. and expects to earn in excess of annual allowable limit.

   

S3

Auxiliary’s benefits withheld because of S2 status of primary beneficiary.

   

S4

Failure to have child in care.

   

S5

Auxiliary’s benefits withheld due to S1 status for primary beneficiary.

   

S6

Check was returned – correct address being developed.

   

S7

Disabled beneficiary suspended due to refusal of vocational rehabilitation; imprisoned; extended trial work period.

   

S8

Suspended while payee is being determined.

   

S9

Suspended for reason not separately defined.

   

SD

Technical entitlement only. Beneficiary is entitled on another claim.

   

SF

Special age 72 beneficiary fails to meet residency requirement.

   

SH

Special age 72 beneficiary is receiving a Government pension.

   

SJ

Alien suspension.

   

SK

Beneficiary has been deported.

   

SL

Beneficiary resides in a country to which checks cannot be sent.

   

SM

Beneficiary refused cash benefits (entitled to HI-SMI only).

   

SP

Special age 72 beneficiary suspended due to receiving public assistance.

   

SS

Post secondary student summer suspension.

   

SW

Suspended because of worker’s compensation.

REVISED 08/01/11 – CHANGE NO. 01-12

IV.C.5. CONT’D

Terminated:

TA

Terminated prior to entitlement.

   

TB

Mother, father terminated because beneficiary is entitled to disabled widow(er)’s benefits.

   

TC

Disabled widow attained age 62 and is not entitled as an aged widow.

   

TJ

Advanced – filed claim terminated after maturity.

   

TL

Termination of post secondary student.

   

TP

Terminated because of change in type of benefit or post-entitlement action.

   

T

Converted from disability benefits to retirement benefits upon reaching age 65.

   

T0

Benefits are payable by some other agency.

   

T1

Terminated due to death of the beneficiary.

   

T2

Auxiliary terminated due to death of the primary.

   

T3

Terminated due to divorce, marriage or remarriage of the beneficiary.

   

T4

Child attained age 18 or 22 and is not disabled; mother/father terminated because last child attained age 18.

   

T5

Beneficiary entitled to other benefits equal or larger.

 

Terminated:

T6

Child is no longer a student or disabled; or the last entitled child died or married.

   

T7

Child beneficiary was adopted.

   

T8

Primary beneficiary no longer disabled or the last disabled child no longer disabled.

   

T9

Terminated for reason not separately defined.

       
 

Uninsured:

U

Beneficiary is entitled only to HI or SMI.

       
 

Withdrawal

W

Withdrawal before entitlement.

       
 

Other adjustment

X0

Claim transferred to RRB.

   

X1

Beneficiary died.

   

X5

Entitled to other benefits.

   

X7

HIB/SMI terminated.

   

X8

Payee is being developed.

   

X9

Terminated for reason not separately defined.

   

XD

Withdrawn for adjustment.

   

XK

Deportation.

   

XR

Withdraw from SMI.

REVISED 08/01/11 – CHANGE NO. 01-12

IV.C.5. CONT’D

REVISED 08/01/11 – CHANGE NO. 01-12

IV.C.5. CONT’D

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IV. D. HIB Entitlement (Part A)

HIB Entitlement (Part A)

Type :

Free

Premium Amount :

$0.00

Enrollment Period :

 

Entitlement Date :

1/2001

HI Start Date

3/1/2004

 

1/1/2001

   

HI End Date

   

3/1/2004

   

Basis for Insurance

Age

 

Disabled

   

Reason If Not Covered

   

Age 65 Convert

   

3rd Party Premium Payer :

 

3rd Party Category :

 

3rd Party Premium Start Date :

 

3rd Party Premium End Date :

 

REVISED 08/01/11 – CHANGE NO. 01-12

IV. D. (CONT’D)

Initial Enrollment Period

Not within any enrollment period

Qualified Medicare Beneficiary enrollment

Reinstated following appeal

Special Enrollment Period

Transfer

Unknown

Enrollment based on EBO provisional

No Medicare waiting period

REVISED 08/01/11 – CHANGE NO. 01-12

IV. D. (CONT’D)

Age 65 Convert

Denied

Invalid enroll

No longer renal

Premium

T2 Term

Voided enrollment

Enrollment withdrawal

REVISED 08/01/11 – CHANGE NO. 01-12

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IV. E. SMI (Supplemental Medical Insurance) Entitlement (PartB)

SMI Entitlement (Part B)

Enrollment Period :

General Enrollment Period

Entitlement Date :

7/2006

Premium Amount :

$115.40

   

SMI Start Date

7/1/2006

     

1/1/2001

SMI End Date

       

6/1/2003

Basis for Insurance

Age

 

Age

 

Disabled

Reason If Not Covered

   

Refusal

 

Enrollment Withdrawal

3rd Party Premium Payer :

340

Variable SMI Premium :

$96.50

3rd Party Category :

State

Variable SMI Start Date :

1/2010

3rd Party Premium Start Date :

12/2010

Variable SMI End Date :

1/2011

3rd Party Premium End Date :

     

REVISED 08/01/11 – CHANGE NO. 01-12

IV.E. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

IV. E. (CONT’D)

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IV. F. Payment History

Payment History

Railroad Claim ID :

 

Railroad Jurisdiction Start Date :

 

Railroad Status :

 

Railroad Jurisdiction End Date :

 

Date

Amount

5/1/2011

$695.00

4/1/2011

$695.00

3/1/2011

$695.00

2/1/2011

$695.00

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IV. G. Logoff Procedures

Click the Log Out button.

REVISED 08/01/11 – CHANGE NO. 01-12

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V. USE OF FORMS

A. Use form DMA-5049 (Referral to local Social Security Office) for Medicaid clients who:

B. Use form SSA-1610 (Information Request and Report) to:

REVISED 08/01/11 – CHANGE NO. 01-12

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VI. MESSAGE LIST

A. Payment Status Messages

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A.1. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“A BENEFICIARY WHO HAS BEEN ENTITLED TO HIS ONLY IS NOW BEING AWARDED MONTHLY BENEFIT”

A recipient who has been entitled to hospital insurance to hospital insurance benefits only is now being awarded monthly Social Security payment. A subsequent BENDEX verifies the new benefit amount.

“RECOMPUTATION”

SSA is re-computing the person’s SSA payment. A subsequent BENDEX verifies the new amount.

“SPLIT PAYMENTS” (Advance File Only)

A husband and wife’s benefit formerly combined into one check is now being split. Each receives a separate check. A subsequent BENDEX verifies the new amount.

“CHANGE IN PAYMENT IDENTIFICATION CODE OR POST ENTITLEMENT ACTION”

Self-explanatory. A subsequent BENDEX verifies the new amount.

“SIMULTANEOUS ENTITLEMENT”

Person is entitled under two account numbers. A subsequent BENDEX PROVIDES BENEFIT AMOUNTS.

“WORKMAN’S COMPENSATION OFFSET IS BEING IMPOSED”

Benefits are being adjusted because the recipient is receiving workman’s compensation. A subsequent BENDEX verifies the Social Security.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A.1. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“STATUS IS BEING CHANGED FROM NON-PAYMENT TO CURRENT PAYMENT STATUS”

A recipient who has not been receiving payment is now being awarded monthly benefits. A subsequent BENDEX verifies the new amount.

“STATUS IS BEING CHANGED FROM CURRENT-PAYMENT STATUS TO DEFERRED-PAYMENT STATUS”

A recipient’s monthly Social Security Benefits have been postponed for future payment.

“ABATEMENT STATUS”

A claim was filed but the recipient died prior to entitlement.

“BENEFICIARY IN CURRENT PAY STATUS”

Recipient receives Social Security.

“CURRENT PAYMENT, ADVANCE FILING”

Payment is effective on the date shown as initial date of entitlement. Explanation: A payment for November is paid on December 3, etc.

“BENEFICIARY IS ENGAGING IN FOREIGN WORK”

Recipient is engaged in works outside the USA.

“TO RECOVER AN OVERPAYMENT RESULTING FROM BENEFICIARY’S WORK”

SSA is recovering an overpayment due to beneficiary working.

“AUXILIARY’S BENEFITS WITHHELD BECAUSE OF AN OVERPAYMENT RESULTING FROM PRIMARY BENEFICIARY WORK”

Wife/child’s benefits are deferred because the primary beneficiary’s benefits are deferred. SSA is recovering overpayment due to work.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A.3. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“YOUNG MOTHER (under age 62) HAS NO CHILD IN HER CARE”

There is no child in the care of this recipient.

“AUXILIARY’S BENEFITS WITHHELD BECAUSE PRIMARY BENEFICIARY IS ENGAGING IN FOREIGN WORK”

Wife/child’s benefits are being withheld because the primary beneficiary is working outside the USA.

“IN ORDER TO RECOVER AN OVERPAYMENT WHICH RESULTED FOR REASONS NOT ATTRIBUTABLE TO EARNINGS”

SSA is recovering an overpayment.

“FOR REASONS OF MISCELLANEOUS DEFERMENT NOT PROVIDED WITH A SPECIFIC CODE”

Self-explanatory. A subsequent BENDEX may be received showing resumption of benefits.

“BENEFICIARY IS RECEIVING PUBLIC ASSISTANCE”

A PROUTY beneficiary is receiving public assistance or SSI. When public assistance is terminated, the recipient again is eligible for Social Security.

“BENEFICIARY IS RECEIVING WORKMAN’S COMPENSATION”

Pertains only to disability beneficiaries. Workman’s compensation equals or exceeds benefits.

“CONTINUING DISABILITY INVESTIGATION”

SSA is investigating whether the recipient continues to be disabled.

“WORKING BENEFICIARY”

Recipient’s earning have exceeded or are anticipated to exceed the monthly and yearly limits.

“AUXILIARY BENEFITS WITHHELD – WORK STATUS”

Wife/child’s benefits suspended because primary beneficiary’s earnings have exceeded or are anticipated to exceed monthly and calendar year limits.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A.3. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“CHECK RETURNED FOR WRONG ADDRESS

The recipient’s check returned to SSA marked “address unknown.” SSA is investigating.

“DIB BENEFICIARY REFUSED VOC-REHAB”

A recipient of disability insurance benefits refused to accept vocational rehabilitation services.

“PAYEE NOT DETERMINED”

SSA is in the process of establishing a payee.

“UNKNOWN”

Benefits suspended with no specific reason given. (Recipient’s notice from SSA contains a specific reason for suspension.)

“SPECIAL AGE 72 (PROUTY) RECEIVING GOVERNMENT PENSION”

A PROUTY beneficiary is receiving a government pension, which is equal to or greater than benefit.

“BENEFICIARY REFUSED BENEFITS”

The beneficiary refused to accept Social Security benefits. (Entitled to HIB-SMIB only).

“BENEFICIARY HAS BEEN DEPORTED”

Self-explanatory.

“BENEFITS DUE BUT NOT PAID”

Usually less than $1.00.

“TECHNICAL ENTITLEMENT”

Entitlement to a benefit on another claim causes an auxiliary benefit on this claim not to be paid.

“SPECIAL AGE 72 (PROUTY)BENEFICIARY SUSPENDED BECAUSE OF FAILURE TO MEET RESIDENCY REQUIREMENTS”

Recipient not admitted to USA for permanent status.

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VI. A.3. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“ALIEN SUSPENSION SECTIONS OF SOCIAL SECURITY ACT APPLY”

Either recipient has not been admitted for permanent residency and/or has not been in the USA for 5 years. Social Security office can provide reason for suspension.

“BENEFICIARY RESIDES IN A COUNTRY TO WHICH CHECKS CANNOT BE SENT”

Self-explanatory.

“WORKMAN’S COMPENSATION PAYMENTS PRECLUDE PAYMENT OF BENEFITS"

Pertains only to disability beneficiaries. Workman’s compensation equals or exceeds benefits.

SSA MESSAGE

EXPLANATION

   

“ENTITLED TO OTHER FEDERAL BENEFITS”

The benefits are payable by an agency other than SS (For example: VA or Railroad Retirement).

“DEATH OF BENEFICIARY”

Self-explanatory.

“DEATH OF PRIMARY BENEFICIARY”

Self-explanatory. BENDEX data for survivors (widow/children) verifies new Social Security benefits for them.

“BENEFICIARY’S MARITAL STATUS WAS CHANGED”

Self-explanatory.

“CHILD ATTAINED MATURITY”

A child beneficiary attained age 18 (or 22 if an active student) and is not disabled or attending school; or, if beneficiary is a mother/father, terminated based on last entitled child’s attainment of age 18.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A.4. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“ENTITLED ON OTHER ACCOUNT”

The recipient is entitled to benefits on another account.

“CHILD’S STATUS CHANGED”

A child is no longer a student or disabled, or (if beneficiary is a mother/father) the last entitled child died or married.

“CHILD ADOPTED”

A child recipient has been adopted.

“BENEFICIARY RECOVERED”

The primary beneficiary or the last disabled child recovered from a disability.

“TERMINATED-REASON UNKNOWN”

Self-explanatory. The specific reason for termination will be provided in the recipients notice from SSA.

“DISABLED WIDOW(ER) HAS REACHED AGE 65 BEING CONVERTED TO AGED BENEFITS”

Self-explanatory. Claim suffix changes from W to D.

“TERMINATED PRIOR TO ENTITLEMENT”

Self-explanatory.

“ADVANCE FILED CLAIM TERMINATED AFTER MATURITY”

Terminated prior to entitlement. Action too late to stop check from being issued.

“BENEFICIARY BECAME ENTITLED TO WIDOW(ER)’S BENEFITS BASED ON DISABILITY”

Self-explanatory.

“CHANGE OF BENEFICIARY ACCOUNT SUFFIX”

Social Security claim suffix has changed. Example: B to D.

“CLAIM WITHDRAWN”

Self-explanatory.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A.4. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“TERMINATION OF STUDENTS (POST SECONDARY) BENEFITS DUE TO LEGISLATIVE CHANGES IN STUDENT REQUIREMENTS.”

Self-explanatory.

“DEATH OF BENEFICIARY”

Self-explanatory.

“BENEFICIARY ENTITLED TO CASH BENEFITS”

A recipient entitled to hospital or supplemental medical benefits only is now in the process of becoming eligible for cash benefits. Subsequent BENDEX contains the new amount.

“PAYEE NOT DETERMINED”

Self-explanatory.

“MISCELLANEOUS”

Miscellaneous termination reason not provided with a specific code.

“CLAIM TRANSFERRED TO RRB”

Self-explanatory.

“HOSPITAL OR SMI ONLY BENEFITS BEING TERMINATED”

Self-explanatory. SSA can provide reason for termination.

“WITHDRAWN FOR ADJUSTMENT”

Self-explanatory.

“WITHDRAWN BECAUSE FILE IS BEING TRANSFERRED TO ANOTHER PAYMENT CENTER”

Self-explanatory.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. A. 5. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“BENEFICIARY NO LONGER ELIGIBLE FOR HOSPITAL OR SMI ONLY BENEFITS BECAUSE HE/SHE WAS DEPORTED”

Self-explanatory.

“WITHDRAWAL OF SMI BENEFITS (BENEFICIARY WAS ENTITLED TO SMIB ONLY)”

Recipient requested SMI be terminated.

“TERMINATED TITLE XVIII STATUS”

Self-explanatory.

B. SMI (Medicare B) Option

“ENROLLED IN SMIB”

Self-explanatory.

“NO SMI-CESSATION OF DISABILITY”

Recipient recovered from disability.

“SMI DENIED”

Recipient is ineligible for SMI.

“BENEFICIARY ENROLLED FOR SMI UNDER SSA GOOD CAUSE”

Recipient had a good reason for late enrollment for SMI.

“NO RESPONSE FROM BENEFICIARY WHEN ASKED FOR ELECTION CONCERNING SMI”

Self-explanatory.

“INVALID ENROLLMENT HAS BEEN TERMINATED”

Self-explanatory.

“NO SMI TERMINATED BECAUSE OF NON-PAYMENT OF PREMIUMS”

Self-explanatory.

“VOLUNTARY WITHDRAWAL FROM SMIB”

Self-explanatory.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. B. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“BENEFICIARY ENTITLED TO SMIB; RAILROAD RETIREMENT BOARD HAS JURISDICTION FOR PREMIUM COLLECTION”

Recipient is receiving Railroad Retirement benefits. RR Board responsible for collecting premiums.

“SMI REFUSED OR DENIED FOR ALIEN RESIDENT”

Beneficiary refused supplemental medical insurance benefits or was denied for alien resident.

   

“NO SMI; NO LONGER UNDER RENAL DISEASE PROVISION”

Relates to disabled recipient who had kidney transplant or dialysis ended 12 months ago.

C. Communication Code

“AGENCY CONFLICT – INDIVIDUAL ALREADY ACCRETED BY STATE XXX”

Record is in conflict with another state. Fraud may be a possibility.

“RECORD MATCHED”

Record is fully processed with pertinent data extracted from the MBR.

“BENEFITS, IF PAYABLE, ARE PAID TO OTHER THAN BENEFICIARY”

Self-explanatory.

“THE BENEFICIARY WAS TERMINATED MMYY BY SSA. NO FURTHER REPORTS WILL BE FURNISHED UNDER THIS CLAIM NUMBER”

Self-explanatory.

“SSA HAS NOT COMPLETED FULL SEARCH OF THE MASTER BENEFICIARY RECORD AND IS CONTINUING TO INVESTIGATE”

The state should receive a record in the next regular BENDEX run.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. C.1. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“BENEFICIARY IS TERMINATED ON THIS RECORD. THE MBR CONTAINS A CROSS-REFERENCE NUMBER, BUT THE SYSTEM WAS NOT ABLE TO LOCATE THE OTHER RECORD.”

Self-explanatory.

“POSSIBLE ENTITLEMENT UNDER ANOTHER ACCOUNT, BUT SSA IS UNABLE TO DETERMINE THE OTHER ACCOUNT – STATE SHOULD DETERMINE PROPER CLAIM NUMBER AND RESUBMIT TO BENDEX.”

No further exchange is made on this terminated case.

“SSI-RRB” NO TITLE II DATA EXISTS FOR THIS PERSON AT THIS TIME.

Self-explanatory.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. C. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“CLIENT IS TERMINATED FROM BUY-IN-STATE SHOULD REACCRETE IF ELIGIBILITY IS ONGOING”.

No further data exchange through BENDEX.

“STATE HAS DELETED FROM BENDEX DUE TO DEATH OR CLIENT NO LONGER ELIGIBLE ON STATE ROLLS”.

Self-explanatory.

“AGENCY CONFLICT-ACTIVE BENDEX EXCHANGE ONGOING STATE XXX”.

Record is in conflict with another state. One state is deleting their record and receiving no further exchange.

“THE ACCOUNT HOLDER ON THIS ACCOUNT DIED IN MMYY. CLAIMANTS FOR SURVIVOR BENEFITS MAY BE REFERRED TO LOCAL SSA OFF”

Self-explanatory.

“DOB UNM”

Date of birth unmatched on month and year. Processing ceased.

“GIV UNM”

Given name unmatched. Processing ceased.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. C.4. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“IMP CAN”

Impossible claim number. The SSN on the input record is invalid; not all numeric or out of the range issued by SSA.

“IMP CODE”

The communication code on direct input record is either blank or invalid.

“NO AUTH”

Category of assistance code on direct input case is missing or invalid.

“NO DEX”

SSA is unable to determine which action the state is attempting. Accretion and deletion cases received as direct input for same SSN.

“NO FILE”

Claim number in possible range but nonexistent on MBR. No entitlement to SSA benefits on this SSN.

“SUR UNM”

Surname unmatched. Processing ceased.

“?”

Error in SSA Communication Code.

D. Hospital Insurance – (Medicare A) Option

“NO. CESSATION OF DISABILITY”

Self-explanatory.

“NO. DENIED”

Self-explanatory.

“YES. AUTOMATIC ENTITLEMENT, NO PREMIUM NECESSARY”

Self-explanatory.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. D. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“NO. TERMINATED FOR INVALID ENROLLMENT OR ENROLLMENT VOIDED”

Self-explanatory.

“YES. GOOD CAUSE”

Self-explanatory.

“NO NOT ELIGIBLE FOR FREE PART A, OR DID NOT ENROLL FOR PREMIUM PART A”

Self-explanatory.

“RAILROAD JURISDICTION”

Self-explanatory.

“NO. REFUSED FREE PART A”

Self-explanatory.

“NO. TERMINATED NO LONGER ENTITLED UNDER RENAL DISEASE PROVISION”

Self-explanatory.

”NO. TERMINATED FOR NON-PAYMENT OF PREMIUMS”

Self-explanatory.

“NO. WITHDRAWAL FROM PREMIUM PART A”

Self-explanatory.

“YES. PREMIUM PART A IS PAYABLE”

Self-explanatory.

“NO. PART A TERMINATED DUE TO DIVORCE, MARRIAGE, DISABILITY RECOVERY OR MISCELLANEOUS”.

Self-explanatory.

E. SSI Indicator

“TERMINATED DUE TO EXCESS INCOME CAUSED BY TITLE II BENEFIT RATE INCREASE”

First month of non-eligibility.

“CONDITIONAL SSI PAYMENT”

First month of entitlement.

“DENIED”

Denial date.

REVISED 08/01/11 – CHANGE NO. 01-12

VI. E. (CONT’D)

SSA MESSAGE

EXPLANATION

   

“BENEFICIARY IS ELIGIBLE FOR SSI”

First month of entitlement (Initial or first month of entitlement after redetermination).

“ENGAGING IN SGA, NOT ELIGIBLE FOR SPECIAL SSI PAYMENT BUT RETAINS ELIGIBILITY FOR TITLE XIX AND TITLE XX”

First month of non-eligibility for payment.

“INELIGIBLE SPOUSE, PARENT, ESSENTIAL PERSON”

Date of filing.

“ENGAGING IN SGA; ELIGIBLE FOR SPECIAL SSI PAYMENT”

First month of entitlement.

“PENDING SSI DETERMINATION”

Date of filing.

“ENTITLED TO SSI STATE SUPPLEMENT ONLY”

First month of entitlement.

“NON-PAYMENT”

First month of non-eligibility.

“RETURNED CHECK, DATE OF DEATH QUESTIONABLE”

Month check returned, Title XVI and Buy-In terminated; Title II not terminated until valid date of death received.

“TERMINATED (T30), BUT NOT REACCRETED”

First month of non-eligibility.

“STATE SUPPLEMENT TERMINATED”

First month of non-eligibility. (No longer used.)

“TERMINATED-DEATH”

First month of non-eligibility.

“TERMINATED-EXCESS INCOME”

First month of non-eligibility.

“TERMINATED-EXCESS RESOURCES”

First month of non-eligibility.

REVISED 08/01/11 – CHANGE NO. 01-12

Top Of Page

VII. DEFINITION LISTING

REVISED 08/01/11 – CHANGE NO. 01-12

VII. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

VII. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

VII. (CONT’D)

Top Of Page

VIII. SSA SYSTEMS INTERFACE IDENTIFICATION CODES

A. SSI Only Claim Number Suffixes

SA - Aged individual or spouse
SB - Blind individual, spouse or child
SD - Disabled individual, spouse or child
SE - Essential person only
SP - Ineligible parent
SS - Ineligible spouse
ST - Essential person only (ineligible parent or spouse)

B. State Codes

REVISED 08/01/11 – CHANGE NO. 01-12

VIII. (CONT’D)

C. SSA Suffix Codes

REVISED 08/01/11 – CHANGE NO. 01-12

VIII. C. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

VIII. C. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

VIII. C. (CONT’D)

REVISED 08/01/11 – CHANGE NO. 01-12

VIII. C. (CONT’D)

D. Railroad Retirement Prefix Codes

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