All Retroactive Adjustment Requests must comply with CMS Guidelines and Regulations, which include:

• • • • • Medicare Advantage and Part D Enrollment and Disenrollment Guidance.
        • Medicare Managed Care Manual of Chapters Chapter 17, Subchapter D Medicare Cost Plan Enrollment and Disenrollment Instructions and Medicare Prescription Drug Benefit.
        • Medicare Managed Care Manual of Chapters Chapter 13 – Premium and Cost-Sharing Subsidies for Low-Income Individuals.
        • Programs of All-Inclusive Care for the Elderly (PACE) Chapter 4 – Enrollment and Disenrollment.
        • Medicare-Medicaid Plan Enrollment and Disenrollment Guidance.
        • CMS published Health Plan Management System (HPMS) memos.

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.