May 21, :00-3:00 PM Eastern

Transcription

1 An Update from Infocrossing on Enrollment May 21, :00-3:00 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 Agenda I. Welcome and Roll Call (Michelle Soper, ICRC) II. Infocrossing Services (Michael Kettaneh, Infocrossing) A. Introduction and Background B. Medicare Eligibility Processing Online Eligibility Queries, Automated/Batch and Web Service Eligibility Queries C. Enrollment and Change Transactions Online Processing, Automated/Batch Submissions D. CMS Response Files including Daily Transaction Reply Report (DTRR) III. Lessons Learned for Early Capitated Financial Alignment Implementers (Michael Kettaneh) IV. Questions and Answers (Michael Kettaneh and Giman Kim, MMCO) V. Concluding Remarks (Michelle Soper) 2

3 Participants Michelle Herman Soper Senior Program Officer Center for Health Care Strategies Michael Kettaneh Supervisor, Enrollment and Eligibility Systems Infocrossing Giman Kim Health Insurance Specialist Medicare-Medicaid Coordination Office, CMS 3

4 MMP Medicare Transaction Processing: Using the Infocrossing Application May 21,

5 Background Overview Founded d in Continuously contracted t with CMS to provide Medicare Eligibility and Enrollment services. Comprehensive data center services and solutions across all platforms. National footprint with five fully-redundant US data centers. Infocrossing Health Care Services provides contracted t services and enterprise software to Managed Care Organizations. Currently assisting over 200 Medicare Advantage, Part D and MMP Contracted Plans with Eligibility and MARx transaction submission services to CMS. Five MMP demonstration states (MA, IL, VA, CA and OH) are currently in production mode. 5

6 Overview: Medicare Enrollment Requirements Medicare transaction processing requirements Data Processing Management is essential 1. Enrollment transactions must be processed quickly and accurately 2. CMS Transactions must be reconciled 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. No need for States/MMPs to establish connection line with CMS 6

7 Integrated Service Offerings Overview 7

8 Integrated Service Offerings Overview Medicare Eligibility TXN Processing CMS Reports - Files CMS Changes 8

9 Interface Overview PC based TXNS Client FTP processes State/MMPs need to be aware of all existing services to maximize efficiencies Internet Contact IHS Help Desk for additional information on file transfer processes IHS SFTP Server IHS Website 9

10 Web Portal: Eligibility and Enrollment 10

11 Web Portal: Eligibility and Enrollment 11

12 Web Portal: Eligibility and Enrollment 12

13 Batch File Submissions and Response Files MMP Technical Guide version 2.0 dated 01/06/2014 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 13

14 Batch File Submissions and Response Files 14

15 Batch File Submissions and Response Files 15

16 Batch File Submissions and Response Files 16

17 CMS File Submission and Response Files Infocrossing will submit all accepted enrollment, disenrollment, and change transactions to CMS. Transactions can be transmitted to CMS up to three times per day seven days per week. The transmission times occur at 07:00 A.M., 04:00 P.M. and 08:00 P.M., all times are PST. Report of all CMS submitted transactions ti is provided d 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. 17

18 Pre-Enrollment Processing State activities prior to MMP enrollment file submission Check Medicare eligibility frequently State must seek up-to-date eligibility updates from CMS through available sources below: CMS Batch Eligibility Query, Infocrossing s Medicare Eligibility Query Service, MMA Response file, TBQ Query Response, MARx online query, or Infocrossing s s web portal. Use ALL available resources effectively and as frequently as possible!! 18

19 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? Correct HICN (Medicare Claim Number)? Correct Plan ID? Correct Effective Date? Correct Transaction Code? Correct Enrollment Source Code? Have Active Medicare Part A and Part B? Have Full Medicaid? Meet all the MMP eligibility including state-specific eligibility criteria? Individual Alive? Live in MMP s service area? Excluded certain individuals from passive enrollment in accordance with the Three-Way contract? (passive enrollment only) 19

20 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.pdf12 16 Review daily transaction reply py reports (DTRRs)/transaction reply py 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-v80-February- nloads/pcug ar pdf 20

21 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 21

22 Review of Key Points Data Management is crucial to meet CMS compliance. MMP/States should be aware of all Infocrossing-provided tools: 1. Web-based processes; and 2. Automated file transfer tools. Please use the Infocrossing Help Desk as an available resource whenever possible. 22

23 Help Desk Information Infocrossing Help Desk: (877) CMS directed questions: - Plan specific questions: mmcocapsmodel@cms.hhs.gov - State specific questions: fadplanselection@cms.hhs.gov 23

24 Questions and Discussion 24

25 About ICRC Established by CMS to advance integrated t 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: integratedcareresourcecenter@cms.hhs.gov 25