From the Desk of ... Jennifer Young, Executive Vice President, Healthcare Operations
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Madena, Ltd.
From the Desk of ...
Jennifer Young, Executive Vice President, Healthcare Operations
November CMS Software Release: Impacts to Plans
The October CMS Software HPMS memo dated 9/1/2020 has some
interesting changes, and the implementation time frames are
compressed. Health plans must implement the additional data
elements for Preferred Language and Accessible Format by
10/15/2020. Any new 2021 enrollment (TC61) will need to include
these data fields but are listed as optional. The fields must be
"optional" because an alternative language or format does not
apply to all members. However, the implementation of these data
elements in your enrollment submission is not optional. CMS expects health plans to comply with
these changes and send the pertinent information when a member completes those fields on the
enrollment application.
In coordination, there is an additional TC92 and other TRC codes to support ‘personal information
changes’ as well as the CMS response to whether the transaction is accepted or rejected. The TC92
transactions, like the data elements for the TC61, are required for health plans to implement in
their systems, data extract logic for the MARx Input File, and systems that process the Transaction
Reply Report. The TC92 transactions are post-enrollment and do not follow the CPM or CCM
submission timeframes; submissions today will be effective the first day of the month the
submission was accepted by CMS.
What CMS does not say is why this information is needed and how it will be used. In our
experience, CMS collects and gathers data elements to perform compliance analysis. Health Plans
could receive a “TAL”, or Technical Assistance Letter, notifying them that they have failed to
implement the changes based on a lack of these data elements on the TC61 or a lack of use of the
TC92 personal information change transactions. We would also expect that CMS may add this to
their new “Informal Operational Reviews” in 2021 or 2022.
Bottom line: Based on the OIG’s call for greater CMS oversight of MA plans, if this is a new
requirement, expect that there is an oversight process coming down the pipe.
Reach out to Madena's expert team if you need assistance with these changes.
Industry News
August HPMS Memo Summary
~ Sara King, Senior Business Analyst
The August HPMS memos brought additional guidance for 2021
OEC, news of software system changes for MARx Enrollment, and
LIS redeterminations.
Announcement of the October 2020 Software release – Enrollment
Transaction
This memo provides information regarding a systems change
scheduled for the October 2020 release - System Change: New Fields for MARx Enrollment
Transaction
Re-Determination of Part D Low-Income Subsidy Eligibility for 2021
The Part D LIS provides extra help for people with Medicare who have limited income and
resources by helping to pay their Medicare Prescription Drug Benefit costs (plan monthly
premiums, co-payments, and the annual deductible). Read the memo here.
Additional Guidance for the Contract Year (CY) 2021 Online Enrollment Center (OEC)
This memo provides supplemental guidance for the OEC regarding: (1) plan testing of the
new CY 2021 record layout; and (2) the timeline to opt-in to participate in the CY 2021 OEC.
Contract Year (CY) 2021 Online Enrollment Center (OEC) Application Programming Interface
(API)
Beginning with CY 2021, CMS will provide organizations and their contracted third party
vendors and consultants an additional mechanism for downloading OEC enrollments from
HPMS. Read the updates here.
As always, if you need help applying changes or updating systems, contact Madena for assistance.
Madena News
BIC-BEQ API Implementation
~ Mike Gilliland, COO
Madena is excited to kick off our first implementation of CMS’ new
BIC-BEQ REST API for one of our MAPD clients. Based on the June 5th
memo from CMS, MAPDs can leverage these APIs to retrieve the
following:
Demographics
Entitlement/eligibility
Part D employer subsidy
Low Income Subsidy (LIS)
End Stage Renal Disease (ESRD)
Uncovered months
Enrollments
Ineligibility due to not lawful presence or incarceration
Comprehensive Addiction and Recovery Act (CARA) details
Integrating these APIs with the Eligibility Business rules in Madena’s Synchronicity™ system allows
us to help our clients reduce eligibility processing time by moving the existing BEQ Batch process
to a near real-time eligibility verification service.
If your organization is interested in learning more about integrating your BEQ process with CMS’
new BIC-BEQ API, contact Madena today.
Visit Our
Website
Service Spotlight
Have You Selected Your 2021 Auditors?
~ Sue Dahlkamp, Interim Compliance Officer & Senior Consultant
CMS requires a comprehensive list of audits each year that health
plans must complete successfully to remain compliant. For small or
emergent plans, CMS’ rigorous audit schedule can present a staffing
concern.
Madena offers flexible and affordable Independent Audit solutions.
Our team has decades of experience in Medicare audit consulting
services. We can manage your entire audit requirement, making
sure your plan stays compliant and effective.
Where we can help:
Data Validation
CPE
FDR Delegation Desk & On-site Audits
Internal Operations or Finance
Operational Systems, Processes, P&P
Network Adequacy
Provider Directory Accuracy
Contact us today to reserve your spot in our 2021 audit service schedule. Call 720.428.2650 or be
in touch via email.
Dates & Deadlines
EOY Operational Activities
Health plans are in a flurry preparing for the Annual Enrollment Period (AEP). While CMS has not
yet published their annual end of the year (EOY) processing reminders and due dates for
enrollments, health plans should rely on prior years to have a task list for important EOY
operational activities.
Missed a Linked In post?
Review it here!
Medicare Part C & D Data Validation
Have You Selected Your 2021 Auditors?
Recap of the IEN Conference
Get the Most Out of Your CMS Readiness Review
Visit Our
Website
You can also read
