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576 (07/2026) Chapter 2:Eligibility • Section 11: Medical Related Payments (MRP) Manual notices For programs in ONE, the system will automatically generate most required notices and correspondence with the exception of medical related payments. Situations where manual notices are needed: • When additional information or verification is needed, use the Pend for Additional Information form (OHP 0646A) or Notice of Pending Status (DHS 0210). This will need a local process for tracking and taking action if the pend is not satisfied. • When payments are approved, use the Payments Approved form (APD 0541). • When payments are reduced, denied or end, use the Payments Reduced/Denied/End form (APD 0540). • When an individual moves from SBI to CBI, loses Medicare Savings Program (MSP) eligibility and moves to CBI, or when denying a medical expense, use the Notice of Planned Action – Medical Costs form (APD 540M). The notices should use the ONE case number. If there is not a ONE case number generated and a manual notice is still needed, utilize the application number. Note: Add language from the Decision Notice Prep Tips in the reason section of the notice on 540 series forms. Other resources Program Payments and Supports * includes screenshots: This QRG reviews the various steps to request payments using the Other Payments module, including how to process Medical Related Payments.