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.
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CMS
CMS Releases Update to Spring 2011 MARx Software Release
GOVT Releases Final Medical Loss Ratio Regulations
The Obama administration today issued the final regulations on the much-discussed medical loss ratio. The health-care overhaul bill stipulates targets of 80% for small-business plans and 85% for large-company plans, but the industry had lobbied to make it easier in various ways for insurers to hit those benchmarks. (If they don’t, they’ll have to...
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PCUG 5.3 Released
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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MA Plan Member Lock In – GONE in 2012!
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...
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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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UPDATE: April MARx System Changes
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...
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Medicare and You Handbook – 2011
There seems to be quite a bit of interest as to where you can find a copy of the 2011 Medicare and You Handbook. There are two ways you can get a copy 1) Call Medicare to request a copy: 1‑800‑MEDICARE (1‑800‑633‑4227) 2) Download a copy at the following link: http://www.medicare.gov/publications/pubs/pdf/10050.pdf Happy 2011 Annual Enrollment Period!
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Changes to DDPS (PDE) Edits on 1/1/2011
CMS provided new guidance on HMPS today on changes to their edit logic for PDE transactions submitted to CMS system, DDPS. Summary of Changes: PLAN BID TABLE – New table that contains abbreviated plan bid information including the plan’s ICL, and application for supplemental benefit coverage MANUFACTURER AGREEMENT TABLE - This will be the...
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CMS National Encounter Data Meeting
CMS is planning to begin collection of encounter data from Medicare Managed Care Organizations. Today CMS announced a National Meeting to review the business and technical requirements for encounter reporting to CMS; timelines; impact of ICD-9 to ICD-10 coding and the launch of workgroups. Each organization is allowed an attendee and additional web seats. ...
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