Compliance

MarketProminence is a fully integrated business process management system built specifically to address CMS’s compliance regulations.

• Ensure a process is in place to transmit enrollment and disenrollment transactions to CMS within 7 calendar days of receipt
• Ensure a process is in place to transmit plan-generated enrollment transactions that include active 4RX data
• Implement a process to send individuals an acknowledgment notice within 10 calendar days of receiving an enrollment request from that individual, as well as a confirmation notice within 10 calendar days of receiving confirmation of enrollment from CMS
• Implement a process to send individuals an acknowledgement notice within 10 calendar days if a disenrollment request was received directly from the individual
• Ensure the enrollment process allows for appropriate up-front plan denial or CMS rejection in accordance with CMS requirements
• Establish processes to request enrollment and disenrollment corrections in accordance with CMS requirements