Enter Title

Retro-Enrollment & Disenrollment

100

Describe one scenario where CMS will process a retroactive enrollment?

• When an individual has fulfilled all enrollment requirements, but the MA organization or CMS is unable to process the enrollment for the required effective date.
• Auto-enrollment for full-benefit dual eligible may be retroactive to ensure no coverage gap between the end of Medicaid coverage for Part D drugs and the beginning of Medicare drug coverage.
• When individual is eligible for an SEP due to an extraordinary circumstance beyond his/her control (e.g. a fraudulent enrollment request or misleading marketing practices) and may also permit a retroactive enrollment

200

What does the MA organization have to submit when CMS directs it to send a retroactive enrollment or disenrollment request to resolve a complain?

• A screen print from the Complaint Tracking Module (CTM) or other documentation showing the CMS RO decision and direction to submit the request to the CMS Retroactive Processing Contractor, and;
• A copy of the enrollment or disenrollment request, if one is available.

300

All MA plans are open for ICEP, IEP/D, AEP and SEP enrollment requests, unless what limitation applies?

An approved capacity limit

400

If CMS approves a request for retroactive disenrollment, what must the MA organization return?

Any premium paid by the member for any month for which CMS processed a retroactive disenrollment.

TRCs and Storage

100

Enrollment changes are reported to MA organizations using what type of TRCs?

The “700 series” TRCs

200

What does TRC stand for?

Transaction Reply Code

300

What must MA organizations do upon receipt of a CMS transaction reply?

MA organizations must update their records to accurately reflect each individual’s enrollment status.

400

When it is necessary to send a notice based on the receipt of the TRR, within how many days must organizations issue the notice?

Within ten calendar days of receipt of the TRR.

500

For how long are MA organizations required to file and retain enrollment and disenrollment records?

For current contract year + 10 years.

True/False

100

The request for retroactive enrollment action cannot be due to plan error.

False.

200

Retroactive disenrollment requests can only be submitted to CMS by the MA organization.

False. It can also be submitted by the beneficiary

300

Errors made by an EGHP, such as failing to forward a valid enrollment or disenrollment request within the specific timeframes must be submitted to MA organization for review.

False. It must be submitted to CMS (or its designee) for review.

400

Optically scanned forms stored on disk are not an allowed method for storing records.

False. They are allowed.