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The enrollment process is critical to your success in the Medicare market today. Data collected during the enrollment process is particularly critical and must be sent to the Centers for Medicare and Medicaid Services in a timely manner and should be as complete as possible, as it drives all other systems and data.
This information, at a minimum, should inform CMS of a new member; provide the data that CMS needs in order to pay the plan; and establish a plan record of the member's data (demographic, special status, enrollment spans) for use in reconciling plan data with CMS data in order to ensure accurate payment.
Yet this process has been difficult for many plans, as CMS data is stored and updated in multiple systems and warehouses. Each data source-no one of which is the system of record-can send changes to the others, often overwriting good information in the process. If the plan's own data is as clean as possible, the plan has a good starting point for reconciling its data with CMS data and ensuring proper payment.
PDM offers the Medicare Enrollment Automation solution, which provides efficient enrollment and disenrollment capabilities for both Medicare Part C and Part D.
The Medicare Enrollment Automation application:
- Accepts enrollment, disenrollment, correction and change transactions.
- Creates transfer files to send to CMS, and loads weekly/monthly response files.
- Automatically generates pre- and post-CMS member correspondence.
- Maintains member information.
Benefits
- Helps payers ensure that enrollment data is clean and complete-before submission to CMS
- Streamlines the enrollment process for Medicare Part C and Part D
- Helps ensure that reimbursements are both accurate and timely
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Information
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For more detailed information, please call 1-800-569-1222 or click on the link below.
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