Retroactive Adjustment Requests

All Retroactive Adjustment Requests must comply with CMS Guidelines and Regulations, which include Chapter 2, 7, 17d, 19, and the Prescription Drug Plan (PDP) Guidance. However, plans must also follow CMS’ Standard Operating Procedures (SOPs) when submitting retroactive requests to us. For your convenience all applicable SOPs are provided in the Retroactive Processing SOPs and Submission Toolkit sections and should be used as a step-by-step guide when preparing and submitting retroactive adjustments.


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