CMS has planned a major overhaul of their MARx system impacting enrollment file layouts and changes to TRR processing in April 2011. Here is a run down of the changes:
| IMPACTED SYSTEM / INTERFACE | DESCRIPTION | FROM | TO |
| Enroll Disenroll File | Combining transaction codes 60, 61, 62 and 71 in to a single transaction code 61. The file layout will be changed and processing logic will be updated – MAJOR IMPACT | PLAN | MARx |
| Enroll Disenroll File | Submission Cut-Off Dates are aligning to calendar months, allowing for clear transaction submission based on CMS policy and compliance. – MAJOR IMPACT | PLAN | MARx |
| Enroll Disenroll File | CMS is creating a new process for canceling enroll and disenroll transactions that have already been submitted to CMS. There will be new transaction types (TC 80- enroll cancel and 81 – disenroll cancel) that will cancel the transaction. CMS will no longer allow for ‘opposite’ transactions to cancel transactions. – MAJOR IMPACT | PLAN | MARx |
| TRR | New TRCs from CMS will notify the Plan when retro changes to a member’s NUNCMO and LEP have taken place to a member. All plans will receive this information regardles of enrollment dates and withholding status. – MINOR IMPACT | MARx | PLAN |
| Enroll Disenroll File | CMS will automatically reset a member’s NUNCMO to zero when they turn 65 and enter another IEP for Part D – MINOR IMPACT | MARx | PLAN |
| TRR | Gone are TRC 165 errors! The processing of enrollment and payment are separated with this CMS upgrade and errors in payment processing will NOT block enrollment processing anymore – no more TRC 165! – MINOR IMPACT | MARx | PLAN |
| TRR | Daily TRR Files!This is great news. BCSS files will go the way of the dinosaurs and the TRR will be the daily batch response to plan submissions.In addition to faster response the layout will change to include all of the data that was submitted, confirming the values of the submission transaction– MAJOR IMPACT | MARx | PLAN |
| Enroll Disenroll File | Submit member address changes to CMS using a new transaction code, 76 rather than sending SCC changes to the retroactive processing contractor. – MAJOR IMPACT | PLAN | MARx |
All of this and more will dramatically change the way plans report and exchange data with CMS and MARx. These changes are GREAT NEWS for plans that are prepared to move with CMS. The proposed changes will greatly simplify processing rules and improve traceability with data exchanges with CMS. However for those that do not have a plan and resources to execute will be at a great deal of risk.
Will you be ready to meet the new system and compliance requirements by April 2011?
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