2911.6 Buy-In Process

The buy-in process consists of two separate file exchanges with the Centers for Medicaid Services (CMS). The first file is also called the input file and contains a list of all buy-in actions the state is requesting. This includes requests for new accretions, deletions as well as changes. It is sent to CMS on or about the 21st of each month.

The second file is also called the receiving file. It is primarily a response file to the previously sent input file. CMS will respond to each action requested by the state. In addition, the receiving file may also contain changes and other informational messages initiated by CMS. This file is received on the first Thursday following the first Monday of the month.

Both files use special codes called transaction codes to communicate the specific action. A list of transaction codes is available online through the MMIS. Most actions occurring within the Kansas buy-in system are automatic. However, some actions may be manually entered on the buy-in file.

All Medicare information for an individual is contained on the KEES screen. This information is collected from BENDEX and TPQY records provided by SSA as well as information from RRB. The KEES record is transmitted to the MMIS and is used to initiate buy-in as well as match incoming records from CMS. Because the information is taken directly from SSA's records, it is common for the identifying information contained in KEES to differ from that in the established beneficiary file.

Accretion Requests - Automatic accretion requests are generated for persons meeting the guidelines of this section and are sent to CMS on the next input file according the previously noted cycle.In order for an individual to be accreted to buy-in, the input record sent much match the following elements on the Medicare master record: Medicare claim number Last name First name Sex code Date of birth All state-submitted accretions are screened by SSA to verify Medicare eligibility. In these cases where eligibility exists, the individual's Medicare eligibility date and the state buy-in effective date are compared. If the state buy-in date precedes the individual's Medicare eligibility date, SSA will automatically adjust the state buy-in date to agree with the Medicare eligibility date. NOTE : If an accretion fails to occur when it appears the beneficiary is entitled to benefits, eligibility staff should verify the accuracy of the information in KEES with the local SSA office. If the KEES information is inaccurate, it should be changed to match that contained on SSA's record. If SSA's record is incorrect, eligibility staff should notify the local or regional Social Security Office.

Deletion Requests - Buy-in deletions occur automatically when a beneficiary has appeared ineligible for medical assistance for two consecutive months. The retroactively of the deletion date is limited to two months from the month in which SSA received the deletion request. For example, the state submits a deletion action to SSA in 02-03. The deletion date cannot be earlier than 01-03. If an earlier date is requested by the state, it is adjusted to 01-03.

Change Requests - Buy-in records are also sent to request changes in certain elements on the record, such as the Medicare claim number.