CMS expects Part D sponsors to successfully transfer TrOOP accumulator data for beneficiaries making contract-level enrollment changes during the coverage year, in a timely manner 100% of the time.
Beginning in January 2013, Part D Plans will be considered out of compliance if they do not successfully transfer TrOOP accumulator data within 15 days of the effective date of the new enrollment or, if later, the date of the initial FIR transaction.
To assist Part D Plans/Processors in monitoring FIR transactions the industry has developed the Daily Cumulative Aging Report that will identify every beneficiary with an unsuccessful FIR transaction as of the report date. This report will also provide information regarding the length of time the beneficiary has not had a successful FIR transaction, in addition to other data elements. Information regarding the Daily Cumulative Aging Report and other related documents can be found under Related Documents.
In response to industry request, in 2019 CMS agreed to create a PBM FIR Reject Aging Report that can be used by the PBMs in order to assist the plans in management of their FIR rejects. Each plan can designate individuals from their PBM that can receive a similar report to that of the plan’s Daily Cumulative FIR Aging report, however the following fields that contain PHI have been removed: Group, Cardholder ID, DOB, Gender, HICN, MBI and MBI effective and termination dates. PBMs will use the Transaction ID to find the FIRs in their system.
Effective January 2, 2020 the PBM FIR Reject Aging reports will be sent to the PBM e-mail designated in the plan submitted PBM FIR REPORT Distribution Email. These reports will be sent on the same schedule as the Plan’s Daily Cumulative FIR Aging report, including prior plan years.
For more information on designating a PBM email for the PBM FIR Reject Aging Report see Setting Up Points of Contact for a Contract ID.
The reports are transmitted via secure email. For more information on adding or updating emails that should receive the FIR reports see Setting up Points of Contact for a Contract ID.