Medicare Prescription Payment Plan Reporting Instructions for Part D Sponsors
Relevant to: PDP, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
Disclaimer: The content provided on this site is a summary for informational purposes only, and Grane PBM, Inc. assumes no liability for any errors or omissions in the site’s content. The information does not constitute legal or regulatory advice or replace the original CMS memo. Readers are advised to consult the CMS memo in its entirety and to verify information independently before making any decisions based on this information.
Click here to read the complete memo from CMS.
Introduction
The recent CMS memo outlines essential steps for Part D sponsors managing the Medicare Prescription Payment Plan through the Health Plan Management System. This guidance is aimed at ensuring seamless claims processing using BIN/PCN combinations and mandates specific reporting by October 15, 2024. The procedure entails precise entry of routing values, targeting efficient handling and finalizing of claim transactions for enrollees under this plan.
Key Dates and Deadlines
The purpose of this memorandum is to provide instructions to Part D sponsors for populating
routing identifier values within the Health Plan Management System (HPMS) for the Medicare
Prescription Payment Plan.
- Date: September 13, 2024
- Deadline for reporting Medicare Prescription Payment Plan-specific BIN/PCN: October 15, 2024
- Posting of information on the CMS website: Early November 2024
PACE Compliance
This memo involves PACE (Programs of All-Inclusive Care for the Elderly) compliance primarily in the context of ensuring a smooth claims adjudication process, as PACE participants are often Medicare beneficiaries. It outlines a need for a uniform method of processing Medicare Prescription Payment Plan transactions which affects PACE participants who may opt into these transactions.
Part D sponsors involved with PACE programs must pay careful attention to the reporting and managing of Bank Identification Numbers (BIN) and Processor Control Numbers (PCN) as detailed in the memo. Compliance requires the following actions:
- Reporting Medicare Prescription Payment Plan-specific BIN/PCN values through the HPMS by the specified deadline (October 15, 2024).
- Ensuring that the PCNs start with “MPPP” for identification purposes, and maintaining accurate entry of these identifiers.
- Understanding that these requirements must be met by all related Part D sponsors, including stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage involved with PACE.
Failure to comply with these requirements may lead to processing disruptions that could impact the effective delivery of prescription drug benefits under the PACE program.
Required Actions
The purpose of this memorandum is to provide instructions to Part D sponsors for populating routing identifier values within the Health Plan Management System (HPMS) for the Medicare Prescription Payment Plan.
Part D sponsors must:
1. Report their Medicare Prescription Payment Plan-specific BIN/PCN by October 15, 2024, in the Bid Submission Module within HPMS.
2. Ensure BIN numbers are 6 or 8 numerical digits, while PCN numbers must be within 10 alphanumeric characters and start with “MPPP”.
3. Enter the new effective begin date in the “Effective Date of Change” section and ensure the accuracy of data before saving.
FAQs
- “What is the purpose of the Medicare Prescription Payment Plan memorandum?”
- “How should Part D sponsors populate routing identifier values for the Medicare Prescription Payment Plan?”
- “What electronic claims processing methodology is recommended for the Medicare Prescription Payment Plan?”
- “How can Part D sponsors report their Medicare Prescription Payment Plan-specific BIN/PCN?”
- “What are the requirements for BIN and PCN numbers in the Medicare Prescription Payment Plan?”