CMS Issues Changes to Claims Submissions for Early Retiree Reinsurance Program

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The Centers for Medicare and Medicaid Services (CMS) has announced several changes to improve and streamline the process of submitting claims data for Early Retirement Reinsurance Program (ERRP) reimbursement requests.

On Monday, Oct. 3, 2011, CMS will begin providing specific, claim line-level feedback to sponsors who submit claim lists through a new, fully automated review system.  Given this expedited feedback, all claim lists submitted on or after October 3 must be error-free (it must pass the automated review) in order for the plan sponsor to be able to submit a reimbursement request, and then be approved for payment.  If a claim list is determined to be invalid as a result of the automated review and cancelled from the system, the sponsor may resubmit a corrected claim list.  Similarly, before the automated processing system becomes effective in October 2011, claim lists and reimbursement requests that have errors will be cancelled from the system, and plan sponsors may resubmit them.

To provide plan sponsors with sufficient time to prepare for this level of review, the deadline for plan sponsors to submit error-free claim lists in support of reimbursements received based on a summary of aggregated claims has been extended from Dec. 31, 2011, to March 30, 2012.

Finally, CMS is granting sponsors additional flexibility in submitting detailed claims information, offering options on some elements while maintaining fiscal integrity. Plan sponsors should refer to the updated claim list layouts provided on http://www.errp.gov for guidance on how to supply required data, and to the questions and answers provided below.

Plan sponsors that have questions or additional information should contact the ERRP Center at http://www.errp.gov/contact_us.shtml.  For more information, visit: http://www.errp.gov/newspages/20110912-cms-claim-list-update.shtml.

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