Revisions to the Retroactive Processing Contractor’s Toolkit and Standard Operating Procedures are now available! Please begin using the new materials found under our “Retroactive Processing Services” menu immediately. NOTE: All Plans will be required to use the 2011 materials by January 16, 2012.
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Introduction
Welcome to the CMS Retroactive Processing Contractor (RPC) menu. Within the RPC menu you will be able to obtain background information on the Retroactive Enrollment and Payment Validation Program as well as, download information and materials to properly submit any retroactive request for timely processing. On the left you will find several submenus, which contain information and resources on most of the services we offer on behalf of the Centers for Medicare & Medicaid Services (CMS). If you are unable to find the information or tools you need to administer or submit retroactive requests for any plan, please complete the request for information or assistance form on the Contact Us RPC submenu option.
Overview of the Retroactive Processing Contract
Effective August 3, 2009 Reed & Associates, CPAs. (Reed) was designated by CMS as the national contractor responsible for processing retroactive transactions for all Medicare Advantage Organizations, Part D Sponsors, Cost-based Plans and PACE Organizations. Under the terms of this contract, Reed validates and processes retroactive requests for enrollments, disenrollments, PBP changes, health status category changes, state and county code changes, and dual-eligibility status changes for LIS and Medicaid beneficiaries. All requests submitted by organizations must be in accordance with the processes outlined in the Standard Operating Procedures (SOPs) developed by CMS. In addition, all retroactive adjustment requests are reviewed against the guidelines established in the Medicare Managed Care Manual of Chapters 2, 7, 17d, and 19 and the Prescription Drug Plan (PDP) Guidance.
As the prime contractor of the Retroactive Processing contract, it is our responsibility to support CMS’ program integrity efforts and to safeguard program funds by processing retroactive requests, administering monthly certifications (Attestations), and performing comprehensive analysis on all applicable enrollment data submitted by plans to identify possible trends and outliers. All data and trend analysis is provided to CMS (Central Offices and Regional Offices) for further action and outreach counseling to all participating plans.
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