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View Medicare Part D Enrollment Rejection Notifications

User Roles:

AM

AR

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Overview

This section provides an overview of the following topics related to viewing Medicare Part D Enrollment Rejection Notifications:

Introduction to Medicare Part D Enrollment Rejection Notifications

A Medicare Part D Enrollment Rejection Notification is information provided by the Centers for Medicare & Medicaid Services' (CMS') Retiree Drug Subsidy (RDS) Center advising the Plan Sponsor that a Qualifying Covered Retiree (QCR), for whom they are requesting Subsidy Payments, has attempted to enroll in Medicare Part D.

Authorized Representatives, Account Managers, and Designee with View/Send/Receive Retiree Data privilege may view Medicare Part D Enrollment Rejection Notifications on the RDS Secure Website. In addition, CMS' RDS Center sends a notification in the Weekly Notification File with a Reason Code 20 - Beneficiary attempted to enroll in Medicare Part D and received initial rejection.

Any beneficiary that is eligible for Medicare Part D may sign up for that benefit during Medicare open enrollment. When a Plan Sponsor is requesting subsidy for a QCR that attempts to enroll in Medicare Part D, the QCR receives an initial enrollment rejection from Medicare. Plan Sponsors may not receive subsidy for any beneficiaries that are enrolled in Medicare Part D.

After the initial Medicare Part D Enrollment Rejection, a QCR may choose to override the rejection and enroll in Medicare Part D, regardless of their subsidy status. If the QCR chooses to override the rejection, the Plan Sponsor's subsidy for that QCR is terminated and CMS' RDS Center notifies the Plan Sponsor. Only the initial Medicare Part D Rejection Notification is available to view online using the RDS Secure Website. CMS' RDS Center sends a notification in the Weekly Notification File with a new Subsidy Period and a Reason Code 10: Enrolled in Medicare Part D.

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What to Do About Medicare Part D Enrollment Rejection Notifications

The Medicare Part D Enrollment Rejection Notification is your cue to contact the Qualifying Covered Retiree (QCR) who applied for Medicare Part D. Explain to the QCR that your plan has equivalent or better drug coverage, the QCR does not need Medicare Part D, and they cannot have both. If the QCR persists and enrolls in Medicare Part D, you are no longer allowed to receive subsidy for that individual.

Medicare informs CMS' RDS Center if the QCR enrolls in Medicare Part D. CMS' RDS Center recalculates the eligibility for that QCR and sends a Weekly Notification File with the update.

There is no need to inform CMS' RDS Center of the contact with the QCR.

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Timing: Weekly Notification File

A file is created when beneficiaries covered under this application have a notification event such as attempting to enroll in Medicare Part D.

Check the RDS Secure Website regularly. Notifications are processed daily, but email notifications are not sent to Plan Sponsors when information is added to the display screen.

CMS' RDS Center automatically generates a Weekly Notification File for each application. The file includes the Medicare Part D Enrollment Rejection Notifications, in addition to other notifications about beneficiaries with Subsidy Periods for that application.

When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application, CMS' RDS Center no longer creates or sends Weekly Notification Files.

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Troubleshooting Medicare Part D Enrollment Rejection Notifications

No notifications will be displayed if any of the following scenarios is true:

  • No beneficiaries are attempting to enroll in Medicare Part D
  • The last notification is older than 30 days
  • Reconciliation Step 4: Finalize Covered Retirees is marked “Complete”
  • Reconciliation Deadline date has passed for the application

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Accessing Medicare Part D Enrollment Rejection Notifications

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.

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User Roles to Access Medicare Part D Enrollment Rejection Notifications

The Authorized Representative, Account Manager, and Designee with View/Send/Receive Retiree Data privilege may access Medicare Part D Enrollment Rejection Notifications.

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Format of Medicare Part D Enrollment Rejection Notifications

On the Medicare Part D Enrollment Rejection Notification page, there is at least one row per Qualifying Covered Retiree (QCR) who has applied for Medicare Part D and been initially rejected. There may be more than one row per QCR due to gaps in coverage dates or enrollment in multiple plan options.

The Medicare Part D Enrollment Rejection Notifications page displays the following details about each Notification:

  • Notify Date - The date the notification was posted to the RDS Secure Website. It is posted a few days after the QCR attempted to enroll in Medicare Part D. The notification is removed from the RDS Secure Website 30 days after this date.
  • Beneficiary Name - The name of the individual who attempted to enroll in Medicare Part D.
  • Date of Birth - The date the QCR was born.
  • Plan Option - The Benefit Option, within the selected application, for which the QCR currently has subsidy.
  • Subsidy Period Start Date - The date related to a specific Benefit Option, which indicates when a QCR's current subsidy begins.
  • Subsidy Period End Date - The date related to a specific Benefit Option, which indicates when a QCR's current subsidy ends.

Tip: Select the column header to sort the list of notifications.

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Step-by-Step Instructions

This section provides step-by-step instructions to access Medicare Part D Enrollment Rejection Notifications.

To access the RDS Secure Website, and navigate to the Application List page, review instructions to access the RDS Secure Website.

You may choose one of the following methods for accessing the Manage Retirees page:

From the Application List page:

  1. Find the appropriate Application ID.
  2. Select Manage Retirees from the Actions dropdown menu then select Go.

     Select [Manage Retirees]

 

Or

From the Application Status page:

  1. Go to the Application Maintenance Options section at the bottom of the Application Status page.

  2. Select the Manage Retirees link.

     

     Select [Manage Retirees]

On the Manage Retirees page:

  1. Select View Medicare Part D Enrollment Rejection Notifications.

    Note: When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application, CMS' RDS Center no longer posts Medicare Part D Enrollment Rejection Notifications to the RDS Secure Website.

     Select [View Medicare Part D Enrollment Rejection Notifications]

The Electronic Protected Health Agreement opens in a new window.

  1. Select Accept to proceed to the Download Covered Retiree List page or select Cancel to return to the Manage Retirees page.

     Select [Accept]

On the View Medicare Part D Enrollment Rejection Notifications page:

  1. Review the Medicare Part D Enrollment Rejection Notifications.
  2. Select Continue to return to the Manage Retirees page.

     Select [Continue]

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