Effective July 24, 2021, CMS will reject transactions with Election Type Code “S” where the SEP Reason Code field is missing or invalid.
Santa Ana, CA – July 8, 2021 – Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare Advantage, Managed Medicaid, and Marketplace programs, readily accommodates CMS Medicare Advantage Prescription Drug Program System (MARx) submission requirement changes.
In April of this year, CMS issued a memorandum providing notice of upcoming changes to MARx which are effective July 24, 2021. Medicare Advantage plans that submit enrollment and disenrollment transactions via a batch process with an Election Type Code “S” are now required to include a valid Special Election Period (SEP) Reason Code or risk avoidable rejections. Using Dynamic’s feature-rich Enrollment solution, Health Plans can proactively avoid rejections and safeguard compliance with respect to this new submission requirement, as well as all other CMS requirements.
Medicare Advantage Organizations (MAOs) who submit transactions via the MARx User Interface will see two new required fields on the MARx New Enrollment Screen and the Additional Update Enrollment Information Screen:
- SEP Reason Code Group
- SEP Reason Code
When a SEP Reason Code Group selection is made, the corresponding SEP Reason Code drop-down list will be enabled. Users will then be required to select a SEP Reason Code from a list of SEP types.
Users will be able to update SEP Reason Codes that have been submitted incorrectly. Retroactive enrollment and disenrollment transactions with an effective date before the July 24, 2021 release date will require a SEP Reason Code if submitted after July 24, 2021.
“Dynamic’s Enrollment Solution is built around CMS Compliant Regulatory Chapter guidance,” states Jim Corbett, Chief Strategy Officer at Dynamic. “While enrolling beneficiaries into Government Programs is complex, Dynamic’s Enrollment Solution helps MAO’s meet constantly changing regulatory requirements,” Corbett added.
About Dynamic Healthcare Systems
Dynamic Healthcare Systems was founded in 2005 in response to the significant business and system challenges placed on Medicare Advantage Organizations (MAOs) by the enacted Medicare Modernization Act of 2003.
Dynamic provides an end-to-end automated SaaS solution for health plans and provider groups participating in Medicare Advantage, Managed Medicaid, and Marketplace programs.
Our comprehensive solutions can help Dynamic’s clients optimize revenue and increase the quality of their governmental submissions in an operationally efficient manner that is designed to comply with applicable legal and regulatory obligations. The analytics, integrated workflows, and queues within a single integrated platform help Dynamic’s clients more effectively manage Enrollment, Premium Billing, Revenue Reconciliation, and Risk Adjustment. For more information, visit dynamichealthsys.com or call 949-333-4565 ext. 125.