How To View Medicare Part D Enrollment Rejection Notifications - Updated 11/16/2007
The following document describes the Retiree Drug Subsidy (RDS) Medicare Part D enrollment rejection notification process and step-by-step instructions on how to view Medicare Part D enrollment notification on the RDS Secure Web Site. This document includes information about the following:
- What is a Medicare Part D enrollment rejection notification?
- What terminology do I need to understand the Medicare Part D enrollment rejection notifications?
- How do I view the Medicare Part D enrollment rejection notifications on the RDS Secure Web Site?
- What if there are no notifications?
- Why are Medicare Part D enrollment rejection notifications not e-mailed directly to the Plan Sponsor?
- May I download the notifications to a file?
- How will I know there are new notifications for me to view?
- What should I do when I see a Medicare Part D enrollment rejection notification in the RDS Secure Web Site?
- When I receive a Medicare Part D enrollment rejection notification does that mean I will not receive the retiree drug subsidy for the concerned beneficiary is cancelled?
- After I talk to the retiree or beneficiary do I need to notify CMS' RDS Center?
What is a Medicare Part D enrollment rejection notification?
A Medicare Part D enrollment rejection notification is information provided by CMS' RDS Center advising the Plan Sponsor that a beneficiary, for whom they are requesting subsidy payments, has attempted to enroll in Medicare Part D.
Any beneficiary that is eligible for Medicare Part D may sign up for that benefit during open enrollment. However, if a Plan Sponsor is requesting subsidy for a beneficiary that attempts to enroll in Medicare Part D, that beneficiary will receive an initial rejection from Medicare. It is important to understand that Plan Sponsors may not receive subsidy for any beneficiaries enrolled in Medicare Part D.
After the initial Medicare Part D enrollment rejection a beneficiary may choose to override the rejection and enroll in Medicare Part D regardless of subsidy status. If the retiree chooses to override the rejection, the Plan Sponsor's subsidy for that beneficiary will be terminated and CMS' RDS Center will notify the Plan Sponsor. Only the initial Medicare Part D rejection notification will be available to view online using the RDS Secure Web Site. CMS' RDS Center will send you a notification in the Weekly Notification File with new RDS Coverage Period and a Reason Code 10 - Enrolled in Medicare Part D.
What terminology do I need to understand the Medicare Part D enrollment rejection notifications?
Qualifying Covered Retirees - Any individual who is covered under your drug plan for whom you are receiving subsidy payments. This person may be a retiree, spouse, or other dependent(s).
Notification - A notification is a message from CMS' RDS Center concerning a Qualifying Covered Retiree, and their Medicare entitlement or RDS coverage. When there is an event that may impact a Plan Sponsor's ability to receive subsidy payments for a beneficiary, CMS' RDS Center is notified by Medicare. Events that may affect a Plan Sponsor's ability to receive subsidy payments for a beneficiary may include, but are not limited to: a change in Medicare entitlement, the death of beneficiary, or enrollment in Medicare Part D.
CMS' RDS Center will convey notifications and any resulting changes in RDS coverage via a Weekly Notification File. Only the initial Medicare Part D rejection notification will be available to view online using the RDS Secure Web Site.
How do I view the Medicare Part D enrollment rejection notifications on the RDS Secure Web Site?
- After logging onto the RDS Secure Web Site select the Manage Retirees page. You may select the following methods for accessing the Manage Retirees page:
- Application List page or Application Status page.
- Application List page - find the appropriate Application Number. Select the Manage Retirees option in the Actions dropdown list and click the Go button.
- Application Status page - select the Manage Retirees link.
- From the Manage Retirees page select the View Medicare Part D Enrollment Rejection Notifications link.
The Part D Enrollment Rejection Notifications page displays the following details about each notification. There will be at least one row per beneficiary who has applied for Medicare Part D and been initially rejected. There may be more that one row per beneficiary due to gaps in coverage dates or multiple plan options.
- Notify Date - date the notification was posted to the RDS Secure Web Site. It will be posted a few days after the beneficiary attempted to enroll in Medicare Part D. The notification will be removed from the RDS Secure Web Site 30 days after this date.
- Beneficiary Name - name of the individual who attempted to enroll in Medicare Part D.
- Date of Birth - date this beneficiary was born.
- Plan Option - application's benefit option for which this beneficiary is currently covered.
- Subsidy Period Begin Date - date related to a specific benefit option and indicates when a beneficiary's RDS coverage begins.
- Subsidy Period Termination Date - date related to a specific benefit option and indicates when a beneficiary's RDS coverage ends.
You can click on the column header to sort the list of notifications.
What if there are no notifications?
If you access the Part D Enrollment Notifications page and there are no notifications, do not be concerned. If there are no beneficiaries, for whom the Plan Sponsor is requesting subsidy payments, attempting to enroll in Medicare Part D, then there will be no notifications. Additionally, notifications will only remain on this page for 30 days. You will also receive these notifications as part of the Weekly Notifications File.
Why are Medicare Part D enrollment rejection notifications not e-mailed directly to the Plan Sponsor?
The information contained in the beneficiary notifications are classified as Protected Health Information (PHI) and fall under the jurisdiction of Title II, Subtitle F, of the Health Insurance Portability and Accountability Act Of 1996 (HIPAA). As such, this information is protected and transmission and maintenance of it is closely regulated. The methods that CMS' RDS Center uses to disseminate retiree notifications have been selected to best comply with these regulations.
May I download the notifications to a file?
No. CMS' RDS Center will automatically generate a Weekly Notification File for each application. The file will include the Medicare Part D enrollment rejection notifications, in addition to other notifications pertaining to beneficiaries covered by that application. The Weekly Notification File is sent to the Plan Sponsor based on the elected retiree file submission method on the application at the time the notification file is created. A file will only be generated when there are notifications to be sent. It is likely that an application may not receive a file every week. You will only receive a file if something about a beneficiary, covered under the RDS application, changes.
How will I know there are new notifications for me to view?
You should check the RDS Secure Web Site regularly. Because notifications are processed daily, no e-mail notifications will be sent to Plan Sponsors when items are added to the display screen.
What should I do when I see a Medicare Part D enrollment rejection notification in the RDS Secure Web Site?
The notification is your cue to contact the beneficiary who applied for Medicare Part D. You should explain to the beneficiary that he has equivalent or better drug coverage under your plan and that he does not need Medicare Part D. The notification is your indication that they have been initially rejected from Medicare Part D. If the beneficiary persists and enrolls in Medicare Part D you will no longer be allowed to receive a subsidy payment for that individual.
When I receive a Medicare Part D enrollment rejection notification does that mean I will not receive the retiree drug subsidy for the concerned beneficiary is cancelled?
No. The Medicare Part D enrollment rejection notification means that the beneficiary has been initially rejected for Medicare Part D. If the beneficiary overrides the rejection and enrolls in Medicare Part D you will no longer be allowed to receive a subsidy payment for that individual; your Weekly Notification File will indicate such. CMS' RDS Center will send you a notification in the Weekly Notification File with a new RDS Coverage Period and a Reason Code 10 - Enrolled in Medicare Part D.
After I talk to the beneficiary do I need to notify CMS' RDS Center?
No. There is no need to inform CMS' RDS Center of your contact with the beneficiary. If, after your outreach efforts, the beneficiary still enrolls in Medicare Part D, Medicare will inform CMS' RDS Center. At that point, CMS' RDS Center will recalculate the eligibility for that beneficiary and notify you of the change via your Weekly Notification File.
