Common use of Process Description Clause in Contracts

Process Description. ‌ The purpose of the SPAP process is to coordinate the prescription drug benefits between Medicare Part D plans and the State Pharmaceutical Assistance Programs, which serve as supplemental payers. This collection of all prescription drug related benefits will facilitate the tracking of TrOOP (True Out-of- Pocket) expenses incurred by each Medicare beneficiary. In order to coordinate benefits information, data must be collected from each SPAP on each of its enrollees. New submission file formats have been created for use by an SPAP to deliver the pertinent information. This information will be transmitted to the BCRC where it will be edit-checked, and matched against the Medicare data in the Eligibility database. Once a match is found, the BCRC will be able to combine a beneficiary's SPAP information with their Medicare Part D specific information to create a complete record of the beneficiary's state and federal drug benefits. The combined drug benefits information will be loaded into the Master Beneficiary Database (the MBD). Data will be sent from the MBD to the TrOOP Facilitation contractor and Part D plans. An additional file format will be created to send back to the SPAP. This file will contain one status record for each record initially submitted by the SPAP to the BCRC. This response record will indicate if whether or not the SPAP enrollee is a Part D beneficiary; what the SPAP enrollee’s Low Income Subsidy status is; whether or not the BCRC applied the record to the Medicare Beneficiary Database; if the record was not applied to the Medicare Beneficiary Database, why, (e.g., the record contained errors or the record did not provide enough information about the enrollee); what Part D plan the beneficiary is in enrolled in; whether or not the beneficiary is receiving the Low Income Subsidy; and other Part D enrollment and Low Income Subsidy dates and levels.