Medicare Advantage Annual Enrollment Period (AEP) runs from October 15 to December 7. Since most health plans recognize growth this time of year, it is imperative to be prepared to enroll members seamlessly and accurately. Are your systems configured with the latest guidance from CMS? Has your staffing and training efforts increased to ensure work continues to flow as you grow? If these questions cause you pause, here’s some insight on the new CMS guidelines and readiness tips to help you prepare for the upcoming AEP 2023 season.
Recent News—CMS Guidelines
- In June 2022, CMS began a clean-up project to determine if individuals not lawfully present in the S or incarcerated were still enrolled in a Medicare Advantage plan.
- Plan systems should be configured to accept new TRCs 345 through 349 and Adjustment Reason Codes (ARC) 65 and 66
- On July 5, 2022, CMS released new enrollment forms to begin capturing data elements for ethnicity and race. CMS will begin to capture these data elements effective January 1, 2023.
- Plans must use the new enrollment form beginning January 1, 2023
- Beneficiaries are not required to complete these fields
- Plans are required to submit; therefore, internal systems should be configured to capture and send data elements to CMS at the time of enrollment transmission
CMS Annual Checklist—Keep a Look-Out
Plans should use the CMS annual checklist to ensure systems and operations are ready to accept next year’s enrollments. The CMS checklists are typically released late-September through early-October. Be on-the-lookout for this important communication.
AEP 2023 Readiness—Essential Tips to Help You Prepare
- Do you have sufficient staff on hand (or hiring authority) to support membership activities?
- Is the Annual Enrollment Period (AEP) staffing plan based on prior years activity, upcoming enrollment projections, and productivity measures?
- Do you have a Plan B staffing plan if the projections are higher than expected?
- Do you have controls in place to ensure all electronic applications are accounted for and processed in your internal system and submitted to MARx timely?
- Are you prepared to collect data on all Part C and Part D (as applicable) reporting requirements, conduct appropriate data validation, and submit data to CMS according to the requirements?
- Are your Provider and Pharmacy Directories accurate and updated within 30 calendar days of receipt of updated or corrected information from the provider/pharmacy and contain all required data elements?
- Have you implemented procedures to accept BAE (Best Available Evidence) at point-of-sale?
We’re Here to Help
With the Annual Enrollment Period quickly approaching, preparation is essential to welcome new members into your health plan. To help ease the strain and stress of AEP and throughout the year, contact us today for a consultation or a software demo.
ICYMI—Here’s a few more tips and new CMS guidance:
Provider Data Accuracy—Why is it Important
New CMS Guidance for Individuals Not Lawfully Present
About us: CODY® has worked with over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico. We help align internal operations with CMS guidelines to improve regulatory compliance, maximize performance, and streamline member/provider communications across the enterprise. CodySoft® and Membership Suite™™, our proprietary suites of software are designed specifically for health plans. www.codyconsulting.com