Medicare-Medicaid Plan (MMP) Technical Guide to Eligibility and Enrollment Transaction Processing

Author: 
Infocrossing
Published: 
September 2020

This guide describes the interface that states with Financial Alignment Initiative Demonstrations use to conduct Medicare eligibility verification and MMP enrollment submission to the CMS MARx systems. Version 3.3 of the Guide reflects the CMS November 2019 software changes as documented in the HPMS Software release announcements on August 25, 2020 and September 1, 2020.

The changes include modifying the enrollment transaction code 61 to account for two new optional fields:

  • Preferred Language other than English (Spanish or Other)
  • Accessible Format (Braille, Large Print, or Audio CD)

In addition, two new batch transactions codes will be generated on the Infocrossing batch response file when invalid values are found for these new field additions (“2C” for the new optional “Preferred Language Other than English” field and “3C” for the “Accessible Format” field). Finally, the prohibition of MMP enrollment for beneficiaries with ESRD has been removed, effective January 1, 2021.

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