Group Medicare

The Centers for Medicare & Medicaid Services (CMS) is becoming more rigid in enforcement of existing regulation as it relates to employer group plans. In order to fully comply with CMS’s rules:

We can no longer allow retroactive enrollment and disenrollment requests that exceed 80 and 90 days respectively. Under Sections 60.6.1, Enrollment/Disenrollment, "Medicare Managed Care Manual", the effective date for enrollment may be retroactive up to, but may not exceed, 90 days from the date we receive the request.

• Similarly, in Section 60.6.2, we cannot submit a retroactive disenrollment request to CMS if that request is greater than 90 days. Effective immediately, these requirements will be implemented in our enrollment processing activities.
• Please use appropriate enrollment and disenrollment forms: CMS requires that employer groups maintain enrollment/disenrollment forms that meet the conditions specified in its model enrollment and disenrollment documents. You may use your own forms if they meet the CMS requirements, or use our forms. You may transmit data in other formats as long as you keep the required forms on file.

Topics: Medicare