UnitedHealthcare has provided us critical information concerning changes in how they are dealing applications & enrollments moving forward during the AEP. In the recently released Centers for Medicare & Medicaid Services (CMS) 2012 enrollment and disenrollment guidance, CMS issued a change that could result in denied enrollments and affect your commissions when enrollment application forms are not completed accurately and completely.
In order for an MA organization to accept an election, a valid request must be made during an election period. It is the responsibility of the organization to determine the election period of each enrollment or disenrollment request. To make this determination, the organization may need to contact the individual directly. The plan may incorporate specific statements regarding eligibility of an election period with the enrollment or disenrollment request. However, if this information is not provided with the request, the plan must attempt to contact the individual by phone or other communication mechanism, and determine within the ten (10) day requirement if she/he is eligible to make an election at that time.
Though the CMS regulations state that the health plan has 10 days to contact the consumer and determine if they are eligible for the election period, it was later clarified and confirmed by CMS to be 7 calendar days, and the 10 day guidance was in error.
For full details on how this change could affect you, please read 2011 - CMS Change to Enrollment Timeline Guidance (89)