Common use of Process Description Clause in Contracts

Process Description. ‌ The purpose of the file process is to enable coordination of information about prescription drug benefit coverage between Medicare Part D plans and the ADAPs. For ADAPs, this process will facilitate the tracking of TrOOP (“true out-of-pocket”) expenses incurred by each Medicare beneficiary. In order to coordinate benefit information, data must be collected from each ADAP on each of its enrollees. Submission file formats have been created for the partners to use. This input information from a partner will be transmitted to the BCRC where it will be edit-checked, and matched against Medicare data in various eligibility databases. Once a match is found, the BCRC will be able to coordinate the beneficiary’s prescription drug information with the beneficiary’s Medicare Part D information, to create a record of the beneficiary’s prescription drug and Medicare drug benefit coverages. The combined drug benefit coverage information will be loaded into the Medicare Beneficiary Database (MBD). Data from the MBD will be transmitted to Part D plans. A Response File format has been created to be used to return information to the ADAP. It will contain one status response record for each record initially submitted by the partner to the BCRC. The response record will indicate if the enrollee is a Part D beneficiary, the LIS status of the enrollee, whether or not the BCRC applied the record to the MBD and if the record was not applied to the MBD, why not (e.g., the record contained errors or the record did not provide enough information about the enrollee), what Part D plan the beneficiary is in enrolled in, and other selected Part D enrollment information.

Process Description. ‌ The purpose of the file process is to enable coordination of information about prescription drug benefit coverage between Medicare Part D plans and the ADAPsSPAPs. For ADAPsSPAPs, this process will facilitate the tracking of TrOOP (“true out-of-pocket”) expenses incurred by each Medicare beneficiary. In order to coordinate benefit information, data must be collected from each ADAP SPAP on each of its enrollees. Submission file formats have been created for the partners to use. This input information from a partner will be transmitted to the BCRC where it will be edit-checked, and matched against Medicare data in various eligibility databases. Once a match is found, the BCRC will be able to coordinate the beneficiary’s prescription drug information with the beneficiary’s Medicare Part D information, to create a record of the beneficiary’s prescription drug and Medicare drug benefit coverages. The combined drug benefit coverage information will be loaded into the Medicare Beneficiary Database (MBD). Data from the MBD will be transmitted to Part D plans. A Response File format has been created to be used to return information to the ADAPSPAP. It will contain one status response record for each record initially submitted by the partner to the BCRC. The response record will indicate if the enrollee is a Part D beneficiary, the LIS status of the enrollee, whether or not the BCRC applied the record to the MBD and if the record was not applied to the MBD, why not (e.g., the record contained errors or the record did not provide enough information about the enrollee), what Part D plan the beneficiary is in enrolled in, and other selected Part D enrollment information.