CMS CHANGES RULES – READ THE NEW DIRECTORY AND FORMULARY REQUIREMENTS AVOID FINES & SANCTIONS
CMS CHANGES RULES – READ THE NEW
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Equally as important as the ANOC/EOC Mailings, CMS is now requiring monthly updates of Plan Provider Directory books, Pharmacy Directory books and Formulary books. The 2017 Final Call letter to Medicare Advantage Organizations continued to emphasize the importance of material accuracy in Formularies and Plan Provider/Pharmacy Directories. The increased monitoring and enforcement actions especially as to Provider Directories and Pharmacy Directories has been launched due to preliminary data collected by the PNA (Pilot Program) that found severe violations with the Part D and Part C requirements. For example, 1/3 of the psychiatrists listed by a New York Health Plan as Plan Providers were in fact not affiliated with that Plan. CMS has made it clear that it will be issuing fines and enrollment sanctions against Plans that do not keep these materials updated on a monthly basis.
CRITICAL CMS UPDATE
Medicare Managed Care Manual
Chapter 4 – Benefits and Beneficiary Protections:
110.2.2 – Provider Directory Updates (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
Section 110.2.2
“If new information is received – MAO’s are expected to update hardcopy provider directories…. every 30 days.”
PROGRAMMED PDs, Pharmacy PDs and Formularies in Just 24 Hours Print & Mail Books on a Next Day Basis
PROGRAMMED PDs, Pharmacy PDs and
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DMC has developed Proprietary Provider Directory, Pharmacy Directory and Formulary software update programs through which DMC can provide monthly updates to your Plans books in just 24 hours, with no hourly assembly/document creation fees; DMC bills a flat page rate for its program solutions. Just pick up and the phone and by the next day you could have updated Provider Directories, Pharmacy Directories, and Formularies. Plus, DMC provides Translation Solutions and 508 Remediation Solutions on an as needed basis. First time programming of books does require an initial 6.7 hour programming charge in addition to the flat page rate charge; but, all subsequent updates are billed strictly on a flat page rate basis. DMC also offers a Next Day fulfillment program for the mailing of Provider Directories and Pharmacy Directories. Call us today for the most competitive programming rates in the nation.
100% Fully Integrated Perfect Bound Pre-Enrollment Kits (“Welcome Kits”) Get Rave Reviews from Your Agents & Increase Membership
100% Fully Integrated Perfect Bound
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DMC has developed a unique production methodology for the creation of Perfect Bound Pre-Enrollment Kits (PEKs) containing all CMS mandated and Plan requested PEK components for our Health Plan customers. Prior to DMC’s entrance into the Medicare Health Plan market, we are not aware of any Medicare Health Plan that was using 100% fully integrated perfect bound Pre-Enrollment Kits. Multiple paper types, finishes and paper weights are perfect bound into a single book with perforated, removable copies of all Plan and Agent documents such that the Pre-Enrollment Kit becomes a leave behind book with all Member required documents left bound into the book. These attractive PEKs include components such as:
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- Individual Enrollment Request Form (multiply carbonless form with (a) Plan Copy, (b) Agent Copy, and (c) Leave Behind Member Copy that Stays in Book
- Star Ratings Page
- Utilization Procedure Form
- Privacy Notice Form
- Perforated & Removable #9 Reply Envelope
Pre-Enrollment Kits (Welcome Kits) – Available through the Corporate Portal Print-On-Demand Solution in just 3 -4 Business Days (minimum order 250 PEKs) […]