Managing Medicare » Enrollment

CMS Releases Update to Spring 2011 MARx Software Release

jbaker — Fri, 03 Dec 2010 17:56:46 +0000

CMS release though HPMS revised and more detailed requirements for the Spring 2011 MARX Software Release. The PDF is 50MB, you will need to go to HPMS to fetch.

PCUG 5.3 Released

jbaker — Mon, 22 Nov 2010 15:30:56 +0000

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

MA Plan Member Lock In – GONE in 2012!

jbaker — Mon, 22 Nov 2010 15:28:09 +0000

With the issuance of a single memo, CMS has in effect removed the member lock in for MA and MAPD plans with the creation of a new SEP in 2012. The new SEP applies to all members who are enrolled in plans with a STAR rating below a 5 or are enrolled in original Medicare, allowing these members to change plans any time of the year. There are exactly 5 out of 560 plans in 2011 that have a STAR rating of a 5.

What is not detailed in the memo are the restrictions of the new SEP. Are these members allowed to only move to a plan with a higher STAR rating? Can they only move to a plan with a 5 rating or back to original Medicare? I guess these details will be communicated at a later date. In short, this is a game changer for the 2012 bids! Good luck.

HPMS MEMO: SEP to Enroll in 5-star plans

UPDATE: April MARx System Changes

jbaker — Thu, 28 Oct 2010 14:25:39 +0000

CMS today released a HPMS memo providing some minor additional details related to the major system update to CMS’ enrollment and plan payment processing systems in April 2011. The most significant new detail in the memo is that CMS is planning to ‘provide detailed information that Plans will require for implementation in early January 2011.’ No details were provided in this memo. Additionally, CMS restated that they are planning to provide details in the next several weeks that Plans will require for implementation in April 2011.

In short the April 2011 timeline was already known, however the signal that there will be required changes for January 2011 is new. We look forward to receiving the details of these changes to help plans stay with in compliance requirements.

The memo is attached below.

Advance_Announcement_of_April_2011_Software_Release

Be Prepared for Spring 2011 MARx System Upgrades! Will You Be Ready?

jbaker — Tue, 29 Jun 2010 14:33:28 +0000

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?

DOWNLOAD THE CMS MEMO HERE.

VIVA Health, Inc. Selects Dynamic Healthcare Systems Suite

jbaker — Sat, 26 Jun 2010 04:42:18 +0000

FULL DISCLOSURE: I do work for Dynamic Healthcare Systems, but news none the less:

Dynamic Healthcare Systems, a provider of enterprise technology solutions for Medicare-focused health plans, today announced that VIVA Health, Inc., a managed care company with over 32,000 Medicare Advantage members, purchased the Voyager suite including the following modules: Sales/Marketing, Enrollment, Reconciliation, HCC Analytics, RAPS Management and Premium Billing. Dynamic Healthcare Systems is designed to ensure health plans meet the complex compliance and data processing requirements to be properly compensated.

“After reviewing several technology options for managing enrollment and risk adjusted payment, we selected Dynamic’s suite of solutions because they offered the right combination – a comprehensive software solution and expertise in this field,” said Libba Yates, VIVA’s Vice President of Corporate Development. “We value the ability to create an integrated view of our Medicare business and process transactions in a single system.”

The Voyager solutions enable a plan to eliminate compliance risks associated with sales/marketing, enrollment and member management, and risk adjustment requirements by controlling and monitoring operational processes. In addition, plans are able to optimize their premium payments from CMS by correctly, accurately and timely creating, submitting and reconciling enrollment and risk adjustment transactions with CMS.

“To gain a competitive edge today, health plans have to manage and integrate their operations across departments,” said Ken Stockman, Founder and Chief Executive Officer of Dynamic Healthcare Systems. “Voyager is designed to allow plans to eliminate operational barriers between departments and take advantage of the cost and risk reductions and payment optimization that integrated delivery organizations enjoy.”