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The eligibility system provides CMS and its external business partners with a centralized database to exchange beneficiary-specific information. This eligibility system is considered the authoritative source for Medicare beneficiary entitlement and eligibility status for Parts C and D. The enrollment system was created to accommodate changes for the implementation of the Medicare Modernization Act (MMA) legislative provisions. This system interacts with transmissions submitted to CMS from Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans (MA-PDs) and Prescription Drug Plans (PDPs), including the enrollment/disenrollment of beneficiaries and the calculation of payments. Medicare Advantage organizations and PDPs may query these eligibility and enrollment systems using the web-based Beneficiary Eligibility Portal. This portal will allow authorized users access to the entitlement and eligibility information for their plan's Medicare beneficiaries and review enrollment and payment data stored at CMS.
Page Last Modified: 04/10/2008 4:20:06 PM
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