Rise

In 2022, CMS authorized that Medicare Advantage Organizations (MAOs) can offer supplemental benefits, such as dental, vision, hearing, chiropractic, smoking cessation, physical fitness, and transportation as part of plan offerings when those plan bids are below the benchmark amounts for the counties where they operate. Recently, CMS published technical requirements for the submission to the EDPS of supplemental benefit data starting with 1/1/2024 dates of service, and it expects health plans to begin immediately submitting this data with catch-up submission to conclude by the end of 2024. Arguably the most impactful change to the EDPS since its start in 2012, these changes are extremely impactful to MAO’s EDPS operational and financial processes, and this session will focus on MAO readiness to begin submitting this data and ensuring compliance with CMS requirements.

Topics at a Glance:

• An in-depth overview of the CMS requirements for the submission of supplemental benefit data, and how these translate to a compliant ANSI X12 837 that is submitted to the EDPS inclusive of the assignment of Supplemental Benefit Services Category Codes (SBSCs) to the provided benefits, and default data.
  
  
• A high-level overview of an implementation plan for the changes, which includes use case identification, process flow impact analysis, gap analysis, new and revised MAO-002 edits, Tier 2 testing, and catch-up submissions.
  
  
• An overview of new post-production benchmarking and reporting that will be needed to ensure the benefits provided and submitted are aligned with the bid, and to avoid problematic submission patterns.