End-of-Year 2022 Enrollment and Payment Systems Processing—What You Need to Know

As the CMS Annual Rollover process quickly approaches, health plans must prepare to complete critical End-of-Year (EOY) tasks.

Now’s the time to ask—Are your systems configured to process rollover files seamlessly? Does your staff know how to process transactions requiring manual intervention? Any mishaps during this process will create a negative member experience regarding access to care. To ensure your systems and staff are prepared for a successful transition to the new year, here are some important highlights from the End-of-Year 2022 Enrollment and Payment Systems Processing Information HPMS Memo.

EOY Activity Highlights

Beginning on October 4, 2022, plans may start to submit enrollment (and disenrollment) transactions for valid January 1, 2023, effective dates.  

  • Transactions must be submitted using the appropriate application date
  • Plans may not manipulate the application date or other information on the transaction
  • Plans do not have to split batch files by effective date year
  • Plans may submit multiple valid enrollment transactions with varying effective dates in the same MARx submission file
  • Plans may submit transactions for multiple contract numbers in one file

After CMS has performed the annual rollover on November 2 and 3, 2022, plans will be able to submit disenrollments with an effective date of December 1, 2022, for beneficiaries that have rolled over. 

  • Beneficiaries will have an enrollment end date of December 31, 2022, and an enrollment start date of January 1, 2023, with an enrollment source code of “D” for rollover.
  • If the beneficiary decides to disenroll effective December 1, 2022, MARx will shorten the enrollment with a November 30, 2022 end date and remove enrollment for the 2023 gaining plan
  • If a beneficiary makes a valid request to disenroll effective December 1, 2022, or January 1, 2023, and the plan is unable to submit the disenrollment transaction to MARx before December 2, 2022, the plan should submit a category two submission package to the RPC via the Electronic Retroactive Processing Transmission (eRPT) application to have the beneficiary disenrolled.

Unsolicited Paper AEP Enrollment Requests 

  • Plans that receive unsolicited paper AEP enrollment requests prior to the start of the AEP must submit the enrollments into MARx starting on October 15, 2022. Plans must use October 15, 2022, as the application date and the AEP Election Type Code (value = A).

MARX Availability 

  • MARx will be available through November 1, 2022. However, beginning November 2 and 3, MARx will be in “Read-Only” mode during rollover and termination processing. MARx will also be in “Read-Only” mode from November 5, 2022, to November 10, 2022, for December payment processing and completing EOY activities.

We’re Here to Help

With the CMS Annual Rollover process quickly approaching, preparation is essential to welcome new members into your health plan, and ensure existing members transition successfully. To avoid reconciliation nightmares and access to care issues during this process and throughout the year, contact us today for a consultation or a software demo.

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