Response Files. “One for One” Responses Within 15 days of the SPAP input file submission, the BCRC generates and transmits a response file to the SPAP. A response record is generated for each input record as well as responses indicating which records were deleted because they were not included in the current file – it is a “one for one” response system. As a result, the SPAP will receive updated Part D enrollment or LIS status regardless of whether an input record is new, changed or deleted. And an input record that has already been applied in a previous full file submission and that is contained in the current submission unchanged will also generate a response record. In your response files you will get information about beneficiary Part D eligibility and Part D enrollment. We know that the distinction between an individual’s benefit eligibility and benefit enrollment can be confusing. While it sometimes appears that the two terms are used interchangeably, for CMS they have very different and distinct meanings. Once an individual is a Medicare beneficiary, he or she is then eligible to participate in Medicare’s benefit programs, including Part D. Usually, the Medicare beneficiary can choose to participate, and if he or she does, the first day the beneficiary’s participation is effective is the date of enrollment in the benefit program. For example, individuals who have aged into Medicare Part A are then eligible to enroll in Medicare Parts B and D, if they so choose. Once an application for enrollment is accepted, the beneficiary’s effective date of enrollment is determined. In summary, an eligible Medicare beneficiary may participate in Medicare program benefits beginning on his or her date of enrollment in the benefit program. For beneficiaries who choose to participate in the Part D program, the date of enrollment is, usually, the first day of the following month. In the SPAP Response File there are five related fields that can have information about current Medicare Part D eligibility and enrollment. Part D Eligibility Start Date. This will be the first date a Medicare beneficiary has the right to enroll in Part D. It is almost always the effective date of coverage for the beneficiary’s Part A or Part B participation. Information in this data field does not show that a beneficiary has enrolled in Part D. It simply gives the date the beneficiary became eligible to enroll. It is Field 25 in the SPAP Response File. Part D Eligibility Stop Date. This is the date that a Medicare beneficiary has lost the right to enroll in Part D, for any reason. It is Field 26 in the SPAP Response File. The beneficiary’s current Part D Plan is identified in Current Medicare Part D Plan Contractor Number. It is Field 45 in the SPAP Response File. Current Medicare Part D Plan Enrollment Date. This is the effective date of a Medicare beneficiary’s most recent enrollment in Part D. It is the current first date the beneficiary can receive Part D benefit coverage. It is Field 46 in the SPAP Response File. Current Part D Plan Termination Date. This is the last date a Medicare beneficiary can receive Part D benefit coverage from the beneficiary’s current Part D provider. After this date the beneficiary is no longer enrolled, and can no longer receive benefit coverage from the (most recent former) Part D Plan. It is Field 47 in the SPAP Response File. Fields 46 and 47 tell you whether a beneficiary has actually chosen Part D coverage, and the period of time the current benefit coverage is in force. For most SPAP partners, on a routine basis these two sets of fields are the most immediate indicators of Part D coverage.
Appears in 2 contracts
Samples: www.hhs.gov, www.cms.gov
Response Files. “One for One” Responses Within 15 days of the SPAP input file submission, the BCRC generates and transmits a response file to the SPAP. A response record is generated for each input record as well as responses indicating which records were deleted because they were not included in the current file – it is a “one for one” response system. As a result, the SPAP will receive updated Part D enrollment or LIS status regardless of whether an input record is new, changed or deleted. And an input record that has already been applied in a previous full file submission and that is contained in the current submission unchanged will also generate a response record. In your response files you will get information about beneficiary Part D eligibility and Part D enrollment. We know that the distinction between an individual’s benefit eligibility and benefit enrollment can be confusing. While it sometimes appears that the two terms are used interchangeably, for CMS they have very different and distinct meanings. Once an individual is a Medicare beneficiary, he or she is then eligible to participate in Medicare’s benefit programs, including Part D. Usually, the Medicare beneficiary can choose to participate, and if he or she does, the first day the beneficiary’s participation is effective is the date of enrollment in the benefit program. For example, individuals who have aged into Medicare Part A are then eligible to enroll in Medicare Parts B and D, if they so choose. Once an application for enrollment is accepted, the beneficiary’s effective date of enrollment is determined. In summary, an eligible Medicare beneficiary may participate in Medicare program benefits beginning on his or her date of enrollment in the benefit program. For beneficiaries who choose to participate in the Part D program, the date of enrollment is, usually, the first day of the following month. In the SPAP Response File there are five related fields that can have information about current Medicare Part D eligibility and enrollment. Part D Eligibility Start Date. This will be the first date a Medicare beneficiary has the right to enroll in Part D. It is almost always the effective date of coverage for the beneficiary’s Part A or Part B participation. Information in this data field does not show that a beneficiary has enrolled in Part D. It simply gives the date the beneficiary became eligible to enroll. It is Field 25 in the SPAP Response File. Part D Eligibility Stop Date. This is the date that a Medicare beneficiary has lost the right to enroll in Part D, for any reason. It is Field 26 in the SPAP Response File. The beneficiary’s current Part D Plan is identified in Current Medicare Part D Plan Contractor Number. It is Field 45 in the SPAP Response File. Current Medicare Part D Plan Enrollment Date. This is the effective date of a Medicare beneficiary’s most recent enrollment in Part D. It is the current first date the beneficiary can receive Part D benefit coverage. It is Field 46 in the SPAP Response File. Current Part D Plan Termination Date. This is the last date a Medicare beneficiary can receive Part D benefit coverage from the beneficiary’s current Part D provider. After this date the beneficiary is no longer enrolled, and can no longer receive benefit coverage from the (most recent former) Part D Plan. It is Field 47 in the SPAP Response File. Fields 46 and 47 tell you whether a beneficiary has actually chosen Part D coverage, and the period of time the current benefit coverage is in force. For most SPAP partners, on a routine basis these two sets of fields are the most immediate indicators of Part D coverage.. Chapter 5: SPAP Frequently Asked Questions
Appears in 2 contracts
Samples: www.cms.gov, www.cms.gov
