Post-AEP season

Medicare Form

Two months have past since the AEP cutoff and I’m wondering how everyone is managing with their annual Reconciliation Review and Retroactive Adjustment work? This is something I would often wonder about every year for the last six years as the Program Director of the Retroactive Processing Contract (RPC). I would wait week after week from January through April until the discrepancies came in to analyze, process, and report back to CMS. Now I am here in the MAPD community in a new capacity and can come right out and ask: How is everyone doing with their Post-AEP Reconciliation Review?

Over the years, I’ve seen tremendous improvement in the overall performance of each organization’s enrollment operation for AEP since 2008. Organizations are more equipped to handle growth and volume through more efficient systems and trained personnel. The MARx Redesign and Modernization project of 2011 enabled organizations to submit more retroactive adjustments directly to CMS for faster processing. These combined efforts reduced the number of retroactive submissions to the RPC by more than half since 2008. A remarkable achievement!

However, the areas organizations continue to struggle with during Post-AEP season are exception cases. These include cases that fall outside CMS or RPC Guidance, special enrollment clean-up projects, and interpreting CMS policy and MARx system requirements. The reasons behind these commonplace struggles are usually a result of having unique cases that cannot be clearly covered in written guidance, internal systems issues and human error. Regardless of the reason, these issues can leave organizations struggling to resolve hundreds and sometimes thousands of discrepant cases to comply with CMS regulations, avoid Regional Office Approvals, receive timely accurate payments and achieve the highest level of member satisfaction possible.

To kick-off this new journey of bridging Medicare enrollment operations, we are offering our first webinar on Post-AEP Reconciliation and Retroactive Adjustment Processing. This webinar will provide organizations with valuable information on how to organize their discrepancies to ensure the highest level of compliancy and results. We will discuss when to submit directly to MARx for CCM processing versus when to submit to the RPC for Category 2. We will provide valuable tools and information on identifying cases not to submit to MARx to ensure compliancy with your Enrollment Data Validation (EDV) Review. We will share tips on how to prepare your retroactive cases for the RPC to avoid rejections and improve your retroactive enrollment performance. 

The webinar will be aired February 26th at 2:00pm EST.  To register for our webinar please click on the link below.  All registrants will receive a copy of the recorded webinar so even if you are unable to attend the webinar live, still register by February 26th to obtain your copy of the training.  If for some reason you miss the cut-off, contact us at for further instructions on how to obtain a copy.

Please join us on the 26th and let us know how you’re doing with the 2013 Post-AEP Reconciliation Review.  I’m excited to reconnect with everyone and eager to help again! 

Of course always feel free to drop us a note anytime to share any other enrollment issues or questions you may have.  Talk soon! 

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