DI 11035: Medicare for Qualified Government Employment (MQGE) Cases
A. Action when the MQGE claimant has filed a claim with the Office of Personnel Management (OPM)
A claimant who files an application for Medicare based on the worker's Federal employment may have also filed an application with OPM (formerly the Civil Service Commission) for a civil service annuity based on disability. When the claimant has filed with OPM, alert the DDS by an entry in the remarks section of the SSA-3367and include the civil service annuity claim number.
B. Processing MQGE claims
MCS Earnings Computation (EC) is the primary means for processing most claims and provides the yearly earnings and the insured status information, along with the primary insurance amount (PIA) if the individual is insured.
When a medical allowance is returned from the DDS, adjudicate the claim via EC.
When the DDS makes a determination to disallow the claim, process the denial via EC.
NOTE: Whenever possible, process all MQGE claims through EC by indicating “PROCESS AS MQGE (Y/N): Y on the MREQ screen.”
If you cannot process an allowance using MCS EC, adjudicate via A101.
If you cannot process the denial via EC, input the determination via Manual Adjustment Credit and Award Data Entry (MACADE) (see SM 00380.500ff). If the official folder is paper, retain the folder for the six-month holding time.
NOTE: If MCS EC is unable to process the allowance, use the Informational/Certified Earnings Record System (ICERS) to obtain an earnings record (E/R). Review the Earnings Alerts Query (EAQY) for earnings alerts per “Earnings Alerts Query” SM 00355.000.