Transcript ECRS Web April Release - Spring Conference

ECRS Web Enhancements for
Prescription Drug Assistance
Requests
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ECRS Web
Used to notify COBC regarding
• New Other Health Insurance (OHI)
coverage, or
• Changes to existing OHI coverage
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ECRS Web
• OHI information must be communicated promptly
• Missing, inaccurate or invalid OHI records may result in:
• Plans not paying a claim correctly
• Incorrect calculation of a beneficiary’s TrOOP calculation
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ECRS Web
• Did not originally include a transaction to request
modifications to drug coverage
• To modify drug coverage, users submitted the CWF
Assistance Request with:
• Dummy MSP values to pass front-end MSP edits
• Comments to identify the correct Drug Occurrence record to
be updated/deleted and the reason for the request
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Prescription Drug Assistance Request
• Used to update/delete existing Drug Occurrences
• Provides easier, user-friendly interface
• Updates are entered into new data-entry Web pages
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Prescription Drug Assistance Request
• Eliminates use of CWF Assistance Request for Drug
Occurrences
• Including the need to submit dummy hospital and medical
coverage information
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ECRS Web Enhancements
• Use the PDR to submit all Drug Occurrence update/delete
requests
• Majority of requests will be automatically processed, and
• Contractor may receive a response within 24-48 hours
• Do not use the CWF Assistance Request to submit Drug
Occurrence update/delete requests
• Request will not be automatically processed
• Response time will be longer
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New Actions for Drug Occurrence Records
• Added to facilitate all commonly requested updates/special
processing
Action
Action Description
AP
BN
CX
Add Policy Number/Group Number
Develop for Rx BIN
Change Rx Values (BIN, Group, PCN)
GR
PC
PN
Develop for, Group Number
Update Rx Person Code
Develop for/add PCN
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Automated Processing of Certain Actions
• PDRs submitted with the following Actions will automatically
process to speed response time
Action
Action Description
AP
CX
DO
Add Policy Number/Group Number
Change Rx Values (BIN, Group, PCN)
Delete Occurrence
TD
Add Termination Date
• PDR cannot have any reject errors
• Key fields must match an existing Drug Occurrence
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Submitting the PDR
• Verify that the Drug Occurrence is not marked for deletion
• Delete Indicator (on MARx report) does not = ‘Y’
• When a record has been deleted
• Update requests are not feasible
• If the record was deleted in error, it must be added back using
the Prescription Drug Inquiry transaction
• Check ECRS Web to see if transaction was submitted
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Submitting the PDR
• Identify correct Drug Occurrence that requires update/delete
by
• Ensuring data submitted in key fields on PDR match the Drug
Occurrence stored on Medicare’s files
• A Medicare beneficiary may have multiple Drug
Occurrences
• Carefully review daily/monthly MARx files to identify correct
Drug Occurrence to be updated/deleted
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Submitting the PDR
• Primary Drug Occurrence (Record Type = ‘PRI’)
• Submit data that exactly matches the existing primary Drug
Occurrence for the following fields:
Primary Drug Occurrence Key Fields
Field Name
ECRS Web Page
Flat File Position
HICN
Action Requested
89-100
Patient Relationship
Action Requested
250-251
MSP Type
Action Requested
163
Effective Date
Action Requested
262-269
Originating Contractor
Action Requested
286-290
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Submitting the PDR
• Supplemental Drug Occurrence (Record Type = ‘SUP’)
• Submit data that exactly matches the existing supplemental
Drug Occurrence for the following fields:
Supplemental Drug Occurrence Key Fields
Field Name
ECRS Web Page
Flat File Position
HICN
Action Requested
89-100
Person Code
Action Requested
254-256
Supplemental Type
Insurance Information
562
Effective Date
Action Requested
262-269
Originating Contractor
Action Requested
286-290
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Submitting the PDR
• Include all required data elements to:
• Prevent request from being rejected
• Assist COBC Analysts in identifying the correct record
• Required data fields are denoted by asterisks:
• However, additional data may be required depending on the
value(s) submitted in certain fields
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ECRS Web Enhancements
• MSP Occurrence termination/delete requests will be
automatically applied to the linked Drug Occurrence
• CWF Assistance Request with Action ‘TD’ or ‘DO’
automatically applied to the linked Drug Occurrence as long as
there are no reject errors
• Prescription Drug Assistance Request will not have to be
submitted if the linked MSP Occurrence was
deleted/terminated
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ECRS Web Enhancements
• The following Web pages will be displayed when creating a
Prescription Drug Assistance Request
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Action Requested
Informant Information
Insurance Information
Employment Information
Additional Information
Comments/Remarks
Summary
• Web pages are similar to those used for CWF Assistance
Requests
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Prescription Drug Assistance Request
• Users must have proper authorization to use ECRS Web
• Requires an IACS User ID and Password
• Complete self-registration process at:
https://applications.cms.hhs.gov
• For more information on obtaining access to ECRS Web,
please see Chapter 5, Section 10.2.1 at the following link:
• http://www.cms.gov/manuals/downloads/msp105c05.pdf
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Primary Drug Occurrence Update Example
• Existing Working Aged Primary Drug Occurrence
• HICN – 100000000A
• Effective Date – 01012011
• No Termination Date
• Health Plan providing this coverage is notified of the
following inaccuracies:
• Group Number MVP123 is missing
• PCN is incorrect
• Health Plan must submit a Prescription Drug Assistance
Request
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Primary Drug Occurrence Update Example
• Before submitting the PDR
• Ensure that the record is not marked for deletion
• Ensure data in key fields* match
Field Name
Value
*HICN
100000000A (the Member’s HICN)
*Patient Relationship Code
01 (Patient is policy holder)
*MSP Type
A – Working Aged
*Effective Date
01012011
*Originating Contractor
11110
Action
CX (Change Rx Values (BIN, Group, PCN))
AP (Add Policy Number/Group Number)
Group Number
MVP123
PCN
A9939876
Comments
As Applicable
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Supplemental Drug Occurrence Update Example
• Existing Supplemental Drug Occurrence
• HICN – 101000000A
• Effective Date – 12012008
• No Termination Date
• Member notifies their Drug Plan Sponsor
• They have opted out of this plan as of January 5, 2012
• Drug Plan Sponsor must submit a Prescription Drug
Assistance Request
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Supplemental Drug Occurrence Update Example
• Before submitting the PDR
• Ensure that the record is not marked for deletion
• Ensure data in key fields* match
Field Name
Value
*HICN
101000000A (the Member’s HICN)
*Person Code
001
*Supplemental Type
L - Supplemental
*Effective Date
12012008
*Originating Contractor
11110
Action
TD (Add Termination Date)
Termination Date
01052012
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Viewing, Updating or Deleting a PDR
• ECRS Web allows users to view, update or delete a
transaction
• View a transaction to:
• Verify if a submitted PDR was successful (by viewing the
response)
• Determine if a PDR was previously submitted for the desired
change
• PDR can only be updated/deleted:
• By a user with the same contractor number as the originating
contractor number
• When the transaction is in ‘NW’ (New) Status
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Status and Reason
• Used to identify the current state of the transaction
• Prescription Drug Assistance Request is automatically stored
on COBC’s system
• Batch process reads transactions and processes them
• Updated as transaction moves through the system
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Status
• Defines the current state of the record in the COBC system
Status
Description
CM
PDR has been completed
DE
PDR has been deleted
HD
Hold, individual not yet a Medicare beneficiary
IP
In process, being editing by the COBC
NW
New, not yet read by the COBC
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Reason
• Explains why transaction is in a particular status
Reason Codes
Reason
Description
01
Not yet read by COBC, used with NW Status
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Being processed by COBC, used with IP Status
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Under development by COBC, used with IP Status
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Prescription Drug Information sent to MBD, used with CM Status
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File Submissions
• Flat file submission process will include a new PDR File
Type for Prescription Drug Assistance Requests
• Will only include the data needed to process a PDR
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File Submission Methods
• Uploaded via ECRS Web
• Transmitted external to the ECRS Web
• Connect:Direct, or
• SFTP
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Connect:Direct
• Requires FTP connection with a certified Verizon reseller
• Most costly option
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Connect:Direct Input File Naming Convention
• Destination dataset name:
PCOB.BA.NDM.ECRS.INPUT(+1)
Node
1st
Description
Production Files: PCOB
Test Files: TCOB
2nd
BA
3rd
NDM
4th
ECRS
5th
INPUT(+1)
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Connect:Direct Input File Naming Convention
• Indicates if record was accepted, rejected, or updated
• Most files returned within 24 to 48 hours
• Naming convention: PCOB.BA.ECRS.CCCCC.RESP.PS
Node
1st
Description
Production Files: PCOB
Test Files: TCOB
2nd
BA
3rd
ECRS
4th
Plan Number (e.g., H####).
5th
RESP
6th
PS
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SFTP
• New SFTP users must set up a GENTRAN mailbox
• Call the MAPD Help Desk at 800-927-8069, or
• Send an e-mail to: [email protected]
• Current SFTP users may use their existing GENTRAN
mailbox
• Will use the same CMS SFTP Mailbox (organization number)
and IACS User ID for ECRS
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SFTP – Input File Naming Convention
• Naming convention:
GUID.RACFID.APPID.X.UNIQUEID.FUTURE.W.ZIP
Node
Description
1st
IACS User ID
2nd
CMS RACF USERID or “NONE”
3rd
ECRS
4th
D for Daily, W for Weekly, M for monthly, Q for
quarterly, Y for Yearly, A for Ad Hoc
5th
Plan Number
6th
FUTURE
7th
T for test or P for production
8th
If file compressed/zipped
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SFTP – Response File Naming Convention
• Indicates if record was accepted, rejected, or updated
• Most files returned within 24 to 48 hours
• Naming convention:
PCOB.BA.ECRS.CCCCC.RESPONSE.SSSSSSS
Node
1st
Description
Production Files: PCOB
Test Files: TCOB
2nd
BA
3rd
ECRS
4th
Plan Number (e.g., H####).
5th
RESPONSE
6th
Date/time stamp
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ECRS Web
• Most effective method
• Allows information to be input daily, one record at a time or
as a flat file
• Users can view the entered information and see the action
taken by the COBC
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Next Steps
• Curriculum of CBTs to assist you in
• Using ECRS Web
• Understanding the fundamentals of MSP
• We strongly encourage you to complete all appropriate
CBTs offered
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Next Steps
• To register for the curriculum, send an e-mail to
[email protected]
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Company name
Company description
Name
Phone number (formatted ###-###-####)
E-mail address
• E-mail notification will be sent to each registered individual
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Questions
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