A member’s Medicare Eligibility is verified using the Centers for Medicare and Medicaid (CMS) Medicare Beneficiary Database (MBD) as applications are entered either by batch or online. During the verification process, CMS member-specific data such as ESRD, Medicare eligibility dates, LIS, and LIC are automatically added to Member360. Eligibility and Enrollment ( E & E) uses CMS provided edit criteria and MBD validation to determine the status of transactions staged for transmission to CMS.
Plans use Member360 to edit/validate, and submit enrollment related transactions to CMS. Transactions that pass the edit/validation process are transmitted to CMS for processing, and have a 99%+ first-pass acceptance rate:
Benefits:
- Real-time access to CMS provided data (MBD)
- Multiple ways to access data: Online (web site), Batch (manual upload or automated upload), or Web Services (XML)
- Reply within two minutes
- Reply provides critical eligibility related data
- Customer Support by phone and email
- Transactions that fail the edit/validation process are returned to the Plan. Transactions that pass the edit/validation process are transmitted to CMS for processing.
- Reply available within 15 minutes of submission of transactions; rejected transactions rejected can be corrected immediately and re-submitted
- Submission of transactions to CMS scheduled per client preference of time and frequency
- Retrieval of CMS generated reports and files
- Transaction Maintenance Facility provides for the correction/deletion of transactions submitted during the current month
