SSI Advocacy - Letters of Authorization

Patient Billing Services (PBS) receives a listing of SSI approvals for hospital bills that are over 12 months old, and for which they can no longer collect without a Letter of Authorization form.

Periodically, PBS forwards a referral via e-mail to a designated EW with the dates of service for which an LOA is required.

In order to issue an LOA, the SSI client must meet the conditions listed in the MC Handbook. The designated EW must check MEDS:

SSI Advocacy LOA

If MEDS is...

Action

Active

Issues an LOA for the needed months.

Not Active

Sends a fax to SSA to determine if there was SSI eligibility for that time period.

If the client was...

Then the EW...

Eligible for SSI
  • Activates eligibility on MEDS,
  • Completes the LOA process.

NOT eligible for SSI,

Stops the process.

EXCEPTION: If the application was filed within a year of the request for the LOA, the application can be processed for retro months.

Does not have enough information

Completes SCD 169 and sends to SSA.

 

The designated EW may receive a copy of a letter sent to the SSI client (SSA-L8125) regarding their IAR payment. This letter from SSA can be used to verify SSI eligibility to the extent possible. However, this letter does not include the SSI approval date. For any missing information, the designated EW must first view MEDS. If MEDS does not have enough information, complete an SCD 169 and send it to SSA for verification.

SSI Advocacy LOA Process

When the SCD 169 is returned by SSA, the EW reviews the SCD 169 and follows the following steps:

  1. The date of approval is:
    1. Within the last six months, approve the month of request.
    2. NOT within the last six months, deny the LOA request.
  2. If there is:
    1. SSI eligibility for all the months requested, approve the months requested.
    2. NO SSI eligibility for all the months requested go to step 3.
  3. If there is:
    1. A gap in SSI eligibility continue to Step 4.
    2. No gap in eligibility, deny the months without SSI eligibility.
  4. For any months missing SSI eligibility explore if the client should have been eligible for MC under Craig v. Bontá.
    1. If yes, refer this individual to the supervisor to contact the State MEDS Helpdesk via a GadWIN ticket to request they activate Craig v. Bontá.
    2. If no, missing deny the months without SSI eligibility.

      1. Note: Refer the client to apply for MC for those months, if appropriate.

Related Topics

Letter of Authorization