(General Information, Eligibility, and Entitlement Manual)

Change Request Corr ection and Rescind Process   Currently, the CR corrections and rescind process is a manual process, which is completed via email. CMS is automating the CR correction and rescind process utilizing the ECHIMP system. This CR implements the following processes :   CMS will begin distributing Medicare FFS CRs that are being corrected or rescinded for review via a notification from ECHIMP to the current POC Review recipients.  These notifications will specify the type of review to be performed in the subject line of the email (i.e., POC, Correction or Rescind Review).  All current POC Review recipients will receive the notifications whether they are impacted on the CR or not.  The notifications will specify which Medicare Administrative Contractors (MACs) and Shared  System Maintainers (SSMs) are impacted.    Impacted SSMs will review and comment on CRs during the CR's Correction or Rescind Review Period.    Impacted SSMs will update their estimates as a result of the correction or rescind.    Non-impacted SSMs and non- impa cted MACs will be able to review and comment on the draft corrected or draft rescinded CRs in ECHIMP, if they so choose.   CRs that have been corrected and rescinded prior to this automation will not be updated in ECHIMP.  This process will apply to CR corr ections and Rescinds initiated on or after July 5, 2016.  80 - Contractor Workload Transitions  (Rev.108, Issue: 11- 03-17, Effective: 12- 04-17, Implementation: 12- 04-17) Fee-for-Service contractor workload transitions occurred when a Medicare Administrative  Contractors (MACs) period of performance ends or its contract is terminated.  When either of these two circumstances occurs, the outgoing contractor is required to work with the new incoming contractor to transfer the Medicare workload without any disruption to providers and beneficiaries.  During a transition, the outgoing contractor has responsibilities and processes for closing out its Medicare contract and shutting down its operation.  It must also assist the new incoming contractor in its efforts to assume the Medicare claims administration functions.  Concurrently, the incoming contractor is required to establish an operational infrastructure and ensure that all data, records, and functions are properly transferred from the outgoing contractor.  Both parties have a responsibility to ensure that the transition is conducted seamlessly and that all contractual obligations are met during the transition.   80.1 - Transition Handbooks  (Rev.108, Issue: 11- 03-17, Effective: 12- 04-17, Implementation: 12- 04-17) The Medicare Contractor Management Group (MCMG) in the Center for Medicare has developed a handbook in order to assist fee -for-service contractors with the transfer of Medicare workload from one contractor to another.  This is found at:  https://www.cms.gov /Medicare/Medicare- Contracting/Medicare -Administrative -Contractors/Resources -for-MACs.html  Every Medicare workload transition will vary depending on the unique circumstances and environment of the Medicare contractors involved.  There may be activities and processes described in the handbooks that, for various reasons, will not be applicable to a specific transition.  There may also be activities that will need to be performed that the handbooks do not cover.  The handbook cannot identify and address all of  the variations that may occur during a workload transition.  However, the overall activities described in the handbooks for managing a workload implementation or closeout project and the requirements contained therein for meetings, reporting, and providing information, data, and records are part of the IOM and incorporated by reference into the MAC contracts.   90 - Integrated Data Repository (IDR) Claims Sourcing from Shared Systems (Rev. 54, Issued:  10- 01-08; Effective:  10- 01-08; Implementation:  01- 05-09)  The CMS fraud investigation landscape is significantly different today than in the past as a result of program changes, such as the implementation of the Medicare Prescription Drug benefit, competitive selection of contractors responsible for claims administration and program integrity, such as Medicare Administrative Contractors (MACs) and PSCs, expansion of Medi -Medi and Recovery Audit Contractor (RAC) programs, and advent of the Medicaid Integrity Program (MIP).  CMS recognizes the need to signific antly enhance the use of technology to improve its collaborative fraud fighting efforts as well as to establish a modernized data analysis capability for all of Program Integrity.   Today, most Program Integrity contractors have built their own data warehouses and/or avenues for collecting, processing, analyzing data which serves their own individual needs.  These distributed, regional approaches to data analysis do not lend themselves to national analyses, do not represent best practices, and do not take advantage of the cost savings that a centralized data repository would provide.  All of these functions can be better served through a comprehensive set of common data structures and modern tools that encourage collaboration and innovation.  The IDR goal - through incremental releases -  is to be the centralized data repository for all Medicare data.  The Program Safeguard Contractors (PSCs) cannot currently use the IDR exclusively because the source of claims data is the National Claims History (NCH).  The li mited NCH data record is inadequate to support the extensive fraud, waste and abuse investigations that need to be performed by PSCs.  The Shared Systems data are the required data source for Program Integrity.  The CR initiates the acquisition of the Shar ed Systems data for the IDR.  Once the IDR has the required Shared Systems data, Program Integrity and their contractors will increase their ability to detect potential fraud, waste and abuse.   FISS shall provide, in electronic format, all claims output fo r all A/B MACs (A) or (HHH) and claim types on a daily basis at the claims header and detail level for each of the three identified lifecycle phases required.  MCS shall provide, in electronic format, all claims output for all A/B MACs (B)  and claim types on a daily basis at the claims header and detail level for each of the three identified lifecycle phases required.   VMS shall provide, in electronic format, all claims output for all DME MACs and Certificates of Medical Necessity, as required with certain claims for payment, on a daily basis at the claims header and detail level for each of the three lifecycle phases required.   The IDR Lifecycle Phase I is defined as the claim upon enumeration.  The IDR Lifecycle Phase II is defined as the claim immediately  after CWF adjudication.  The IDR Lifecycle Phase III is defined as the claim once financial information has been posted to it. Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R128GI  11/01/2019 Update to General Information, Eligibility, and Entitlement, Chapter 7 -  Contract Administrative Requirements, Section 40.2  Shared  System Maintainer Responsibilities for Systems Releases  12/03/2019 11518 R125GI  07/05/2019 Internet Only Manual (IOM) -  Update to General Informat ion, Eligibility, and Entitlement, Chapter 7 -  Contract Administrative Requirements, Section 40.2  Shared System Maintainer Responsibilities for Systems Releases, Section 40.3.11 Single Testing Contractor (STC) Non -Testable Conditions and Potential Testin g Impacts  08/05/2019 11245 R124GI  05/17/2019 Update to Publication (Pub.) 100- 01 to Provide Language -Only Changes for the New Medicare Card Project  06/18/2019 11240 R122GI  12/21/2018 Updated Instructions for the Change Request Implementation Report (CRIR) and Technical Direction Letter (TDL) Compliance Report (TCR)  05/28/2019 11067 R108GI  11/03/2017 MAC Transition Workload Handbook  12/04/2017 10329 R105GI  06/02/2017 Update to General Information, Eligibility, and Entitlement, Chapter 7 -  Contract Administrative Requirements, Section 40  Shared System Maintainer Responsibilities for Systems Releases