ECRS Web April Release - Spring Conference

Report
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
•
•
•
•
•
•
•
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
02
Being processed by COBC, used with IP Status
03
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]
•
•
•
•
•
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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