Solutions 

FIR Manual Retrigger Requests

FIR Retriggers

Occasionally, it is necessary to request a FIR sequence be initiated outside of the automated process defined in the timing document: FIR Sequence Timing. Most of these requests fall into two categories:

  1. Information/transactions received after the automated period has completed (after March 31st for a prior year, and prior to May 31st). Note that any changes received after May 31st for prior years that meet the criteria for requiring an update to other payers must be handled manually. See CMS Chapter 14 link for more information.
  2. Processor/Plan error has caused FIRs to reject. Some examples of what may cause rejects:
    • Eligibility file mismatches. The plan has sent different 4Rx data to CMS than provided to their processor
    • Processor/Plan coding error that causes FIRs to reject 

In these instances, the Processor/Plan may wish to initiate a FIR outside of the automated process to address the reject as soon as possible. Depending on the volume, CMS may request the Plan to cover the costs of these manual FIR requests. For manual retrigger requests due to normal balance changes or error correction submit your request using:

Manual FIR Retriggers not related to Plan/Systems Issues Form

Timing of FIR Retrigger Requests

Plans may request manual retriggers at any time. However, the standard turn-around time is 2 business days for all requests received prior to 4 pm ET Monday through Friday. Any requests received after 4 pm or on a weekend will be completed within 3 business days. The Transaction Facilitator will process these requests as soon as possible; however, the retriggers will occur no later than the times specified above.

FIR Retriggers due to Plan/Processor System Issues (these are paid for by the Plan/Processor)

For Plan/Processor System issues requiring mass retirggers, please complete the Manual FIR Trigger Request Form below. Upon completion, you may directly submit the request to the Transaction Facilitator and it will be logged and assigned to a representative that will contact you for additional information.

Manual FIR Triggers that are due to Plan/Processor System Issues Request Form

Please note: The Facilitator is required to provide CMS a record of all special data requests requiring development, including the name of the requestor, the date of the request, the data requested, the rationale for the request, and the date the requested work was completed.

For more information regarding the delineation of services covered by CMS versus those covered under commercial agreement see the HPMS memo titled Part D Transaction Facitlitator Updates

 

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