In case you missed the most recent release of the update to the Plan Communications User Guide 5.3, here is the link. Download and review! http://www.cms.gov/MAPDHelpDesk/02_Plan_Communications_User_Guide.asp
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Part D
PCUG 5.3 Released
CMS Reiterates Standards for Selecting a Data Validation Contractor
MA, MAPD and PDP plans are required to report measures to CMS for Part C and D benefits. Additionally, plans are required to contract with an outside vendor to review and validate the data that was submitted to CMS. Attached is CMS’s standards that plans should use to select a validation vendor. Vendor should...
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CMS Releases Proposed Changes to MA and MAPD Programs for CY 2012
CMS on November 10, 2010 release the proposed changes to the MA and MAPD program for CY 2012. The proposed rule changes will is expected to be published in the federal register on November 22, 2010. A headline summary of changes is as follows: Implementing provisions of the Affordable Care Act; Clarifying various program...
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CMS Publishes the 2011 Non-Matched NDC List
CMS and the FDA are coordinating with each other to ensure the market is aware of the changes to the regulatory status of marketed prescription drug products. The Non-Matched NDC List represents drug products that have not been properly registered and listed with the FDA. The non-match FDA list is NOT to be used...
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CMS Posts New ICD-9 / HCC Crosswalk for 2011
CMS has posted an updated Calendar Year 2011 Model Diagnoses crosswalk on the Risk Adjustment webpage. The crosswalk incorporates Fiscal Year 2011 ICD-9 code updates that are effective October 1, 2010. The crosswalk file link is named “2011 Model Diagnoses” and can be found on the CMS Website here: http://www.cms.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp
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HEADS UP: CMS To Announce Encounter Submission Meeting in Oct 2010
During a breakout session at AHIP on September 13, 2010 CMS announced that there will be an October 2010 meeting where CMS will be reviewing the preliminary files, processes and expectations for MA health plans to transition from submitting RAPS files to ‘full encounter’ data. No details were shared at AHIP, but there is...
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CMS Announces STAR Rating Preview and Comment Period
CMS has released a HPMS memo letting MA and MAPD plans know they will be provided a preview period of the STAR Rating that will be published on the Medicare Plan Finder (MPF)for the 2011 open enrollment period. In August 2010 plans were provided a preliminary preview and now the final results are in....
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Additional Changes to 2011 ANOC/EOC
From CMS via HPMS on Sept 3, 2010: “On August 11, 2010, we issued a memo describing corrections to the 2011 Annual Notice of Change/Evidence of Coverage. We have the following additional corrections. 1 – Under the bullet, EOC Chapter 4, section 2.1, Your medical benefits and costs as a member of our plan,...
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CMS Distributes CY 2011 Readiness Checklist
That time of year again! CMS has distributed via HPMS the 2011 MA and PDP Readiness memo. Make sure you incorporate in your plan a review of the checklist and implement any corrective action to ensure your plan is in compliance. CMS has been increasing their review of plans and this checklist is your...
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Be Prepared for Spring 2011 MARx System Upgrades! Will You Be Ready?
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...
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