1 / 67

ECRS Web Enhancements for Prescription Drug Assistance Requests

ECRS Web Enhancements for Prescription Drug Assistance Requests. ECRS Web. Used to notify COBC regarding New Other Health Insurance (OHI) coverage, or Changes to existing OHI coverage. ECRS Web. OHI information must be communicated promptly

kami
Download Presentation

ECRS Web Enhancements for Prescription Drug Assistance Requests

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ECRS Web Enhancements forPrescription Drug Assistance Requests

  2. ECRS Web • Used to notify COBC regarding • New Other Health Insurance (OHI) coverage, or • Changes to existing OHI coverage

  3. 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

  4. 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

  5. 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

  6. Prescription Drug Assistance Request • Eliminates use of CWF Assistance Request for Drug Occurrences • Including the need to submit dummy hospital and medical coverage information

  7. 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

  8. New Actions for Drug Occurrence Records • Added to facilitate all commonly requested updates/special processing

  9. Automated Processing of Certain Actions • PDRs submitted with the following Actions will automatically process to speed response time • PDR cannot have any reject errors • Key fields must match an existing Drug Occurrence

  10. 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

  11. 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

  12. Submitting the PDR • Primary Drug Occurrence (Record Type = ‘PRI’) • Submit data that exactly matches the existing primary Drug Occurrence for the following fields:

  13. Submitting the PDR • Supplemental Drug Occurrence (Record Type = ‘SUP’) • Submit data that exactly matches the existing supplemental Drug Occurrence for the following fields:

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Primary Drug Occurrence Update Example • Before submitting the PDR • Ensure that the record is not marked for deletion • Ensure data in key fields* match

  20. 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

  21. Supplemental Drug Occurrence Update Example • Before submitting the PDR • Ensure that the record is not marked for deletion • Ensure data in key fields* match

  22. 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

  23. 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

  24. Status • Defines the current state of the record in the COBC system • Description • Status • CM • PDR has been completed • PDR has been deleted • DE • Hold, individual not yet a Medicare beneficiary • HD • IP • In process, being editing by the COBC • NW • New, not yet read by the COBC

  25. Reason • Explains why transaction is in a particular status • Reason Codes Description • Reason • Not yet read by COBC, used with NW Status 01 • Being processed by COBC, used with IP Status 02 • Under development by COBC, used with IP Status 03 • Prescription Drug Information sent to MBD, used with CM Status 15

More Related