Enrollment Processing and Technical Assistance for Medicare-Medicaid Demonstration States

Transcription

1 Enrollment Processing and Technical Assistance for Medicare-Medicaid Demonstration States December 16, :00 PM Eastern The Integrated Care Resource Center, an initiative of the Centers for Medicare & Medicaid Services Medicare-Medicaid Coordination Office, provides technical assistance for states coordinated by Mathematica Policy Research and the Center for Health Care Strategies.

2 Participants Michael Kettaneh, Infocrossing Giman Kim, Medicare-Medicaid Coordination Office, CMS 2

3 Agenda Welcome, Introductions, and Roll Call Medicare-Medicaid Plan Enrollment Lessons Learned and Infocrossing Services Questions and Discussion 3

4 Enrollment Assistance and Updates for Financial Alignment Demonstration States December 16,

5 Background Overview Five capitated model demonstration states (MA, IL, VA, CA and OH) are currently in production mode. Six more states are currently being implemented for Total number of MMP contracts for all cap model demo states currently stands at 74. Infocrossing is currently assisting over 270 Medicare Advantage, Part D and MMP Contracted Plans with Eligibility and MARx transaction submission services to CMS. State and MMP organizations must be aware of all existing Infocrossing and CMS services and resources to maximize efficiencies. 5

6 Overview: Medicare Enrollment Requirements MMP MARx transaction processing requirements Data Processing Management is essential 1. Submit your enrollment records timely and accurately to CMS in accordance with the rules stated in the national MMP enrollment guidance 2. Review all daily and monthly CMS reports (Daily Transaction Reply Reports and Full Enrollment Data files) and reconcile enrollment records quickly Infocrossing Applications can be used to help meet CMS requirements 1. Access to Medicare Eligibility information 2. Editing of Medicare transactions to maximize CMS acceptance 3. Management of data file transfer interchanges to/from CMS 4. Storing historical DTRRs and FEFs that are accessible through Infocrossing s web portal 6

7 Integrated Service Offerings Overview 7

8 Integrated Service Offerings Overview 8

9 Web Portal: Eligibility and Enrollment 9

10 Web Portal: Medicare Eligibility 10

11 Web Portal: Medicare Eligibility 11

12 Web Portal: Medicare Eligibility 12

13 Web Portal: Medicare Eligibility Batch File 13

14 Web Portal: Medicare Eligibility Batch File 14

15 Web Portal: Medicare Eligibility Batch File 15

16 Medicare Eligibility - Available resources Infocrossing options: Web Portal Online eligibility query Web Portal Batch submission Web Service. Section 3 of MMP technical guide MBD/BEQ Hybrid process - Automated MBD and BEQ file submissions via SFTP Direct BEQ file exchange between State and CMS (via Infocrossing) BEQ descriptions: see pages 3-1 thru 3-3 of the PCUG Main Guide ( Systems/CMS-Information- Technology/mapdhelpdesk/Downloads/PCUG-Main-Guide-v83- November pdf) File layout: see pages F-45 thru F-47 of the PCUG Appendices ( Information-Technology/mapdhelpdesk/Downloads/PCUG- Appendices-v83-November pdf) 16

17 Web Portal: Medicare Enrollment 17

18 Web Portal: Medicare Enrollment 18

19 Web Portal: Medicare Enrollment 19

20 Web Portal: Medicare Enrollment 20

21 Web Portal: Medicare Enrollment 21

22 Web Portal: Medicare Enrollment 22

23 Batch File Submissions and Response Files 23

24 Batch File Submissions and Response Files MMP Technical Guide version 2.1 dated 05/03/2014 Automated, pre-scheduled and configured file submissions FTP File folder processing sweeps Can be customized to process transaction files at various times Infocrossing Help Desk 24

25 CMS File Submission and Response Files Infocrossing will submit all accepted enrollment, disenrollment, cancellation, and MMP opt-out flag transactions to CMS. State-submitted transactions are sent to CMS up to three times per day, seven days per week: 07:00 A.M. Pacific (10:00 A.M. Eastern) 04:00 P.M. Pacific (7:00 P.M. Eastern) 08:00 P.M. Pacific (11:00 P.M. Eastern) DTRRs available the next following day because these transactions are submitted past the MARx cutoff. Report of all CMS submitted transactions is provided for each submission to CMS. CMS Daily TRR Files (DTRR): Will be made available on the Web Portal; and Can be sent to a designated FTP server. 25

26 Pre-Enrollment Processing State activities prior to MMP enrollment file submission Check Medicare eligibility frequently!! States and MMPs must seek up-to-date eligibility updates from CMS and Infocrossing through all available resources Use all available Infocrossing and CMS resources CMS BEQ or MBD/BEQ exchange process MMA Response file TBQ Query Response Infocrossing s Medicare Eligibility Services MARx Online Query Use ALL available resources effectively and as frequently as possible!! 26

27 Pre-Enrollment Processing State activities prior to MMP enrollment file submission (Continued) Verify the Enrollment file and validate data before you submit Is the file format correct? Is the data accurate and current? o Correct HICN (Medicare Claim Number)? o Correct Plan ID? o Correct Effective Date? o Correct Transaction Code? o Correct Enrollment Source Code? o Have Active Medicare Part A and Part B? o Have Full Medicaid? o Meet all the MMP eligibility including state-specific eligibility criteria? o Individual Alive? o Live in MMP s service area? o Excluded certain individuals from passive enrollment in accordance with the Three-Way contract and Appendix 5? (passive enrollment only) 27

28 Keys to successful MMP enrollments Understand the CMS submission timeframes for enrollment and disenrollment activity This is known as Current Calendar Month (CCM) period. Please see more details about the CCM period on pages 5-7 on the MARx R&M Handbook: and-systems/cms-information- Technology/mapdhelpdesk/downloads/MARx_RM_HANDBOOK_Final_2 010_12_16.pdf Review daily transaction reply reports (DTRRs)/transaction reply codes (TRCs) daily and generate enrollment notices timely - The list of TRCs are available on the I.2 Transaction Reply Codes (pages I-2 ~ I-82) of the Plan Communications User Guide (PCUG) Appendices. The TRC Definition column provides instructions to the State what actions are needed. See PCUG link here: Data-and-Systems/CMS-Information- Technology/mapdhelpdesk/Downloads/PCUG-Appendices-v83- November pdf 28

29 Keys to successful MMP enrollments (continued) Reconcile and validate the internal state enrollment data against the CMS Monthly Reports effectively (i.e. Monthly Full Enrollment Data File, Monthly Membership Report (MMR)) This will help align state MMIS and CMS MARx systems showing the latest MMP enrollment status and will also ensure Plans are getting paid the correct payment from Medicare and Medicaid. Attention to daily file submission/dtrr processing and conducting monthly reconciliation will mean much less manual retroactive enrollment/disenrollment activity. When necessary, state organizations must work with the CMS Retroactive Processing Contractor when enrollment transaction cannot be submitted in time to meet the CCM cutoff rules. Following CMS processing rules and policies is essential. 29

30 Medicare System Processing and Infocrossing s services Data Management is crucial to meet Medicare system processing rules outlined in the CMS PCUG Main Guide and Appendices including the national MMP Enrollment/Disenrollment Guidance. MMP/states are encouraged to use all available resources including Infocrossing-provided tools: 1. Web Portal Service; and 2. Automated file transfer tools. *Please contact the Infocrossing Help Desk whenever possible* (877) , [email protected] 30

31 Challenges and Further Discussion Topics w/ States Examples of the current enrollment challenges: Working with old Medicare eligibility info MMA/TBQ data exchange between CMS and State not frequent enough. Selecting individuals who are not eligible for passive enrollment (ex. employer plan/third party insurance enrollees, OOA status, individuals who do not meet state-specific MMP eligibility criteria). Out-of-sync Medicare and Medicaid effective dates Internal state system communication or file transfer failure; or required correction/action not taken on the rejected CMS DTRR Improper interpretation of the CMS DTRR files and corresponding Transaction Reply Codes (TRCs) Inconsistent data between state s 834 and CMS DTRR (i.e. surname, date of birth, gender code, state/county code, address, etc.) Under-utilization of the CMS Monthly Full Enrollment Data File to cross-compare Medicare and Medicaid membership and its effective dates pertaining to each MMP 31

32 Help Desk Information Infocrossing Help Desk: (877) CMS directed questions: - Plan specific questions: [email protected] - State specific questions: [email protected] 32

33 Questions and Discussion 33

34 About ICRC Established by CMS to advance integrated care models for Medicare-Medicaid enrollees and other Medicaid beneficiaries with high costs and high needs ICRC provides technical assistance (TA) to states, coordinated by Mathematica Policy Research and the Center for Health Care Strategies Visit to submit a TA request and/or download resources, including briefs and practical tools to help address implementation, design, and policy challenges Send additional questions to: [email protected] 34