Exhibit_28_MAPD_File_and_Changes_Reports.xlsx
XLSX spreadsheet 31 KB Posted
- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
This document is an Excel template for Medicare Advantage Prescription Drug (MAPD) File and Changes Reports, likely for a state or federal healthcare program. The file contains two primary reporting tabs - "28a MAPD Changes" and "28b MAPD Full File" - which require electronic submission to an EGID SFTP website. For the "MAPD Changes" tab, reports are due the Wednesday following the reporting week, and must include detailed member disenrollment and changes data such as Social Security Number, member name, Member ID, effective dates, term dates, plan options, and Low Income Subsidy (LIS) information. The "MAPD Full File" tab, due by the 10th of the same month, requires a comprehensive listing of all members enrolled in the MAPD plan.
The reporting template provides specific instructions for data submission, including guidance on enrollment effective dates, disenrollment term dates, Medicare Claim Numbers (HICN), plan options, and Low Income Subsidy percentages (100%, 75%, 50%, or 25%). The document appears to be a standardized reporting mechanism for healthcare providers or insurers participating in a Medicare Advantage Prescription Drug program, designed to track member enrollment, changes, and subsidy status. The template ensures consistent and detailed reporting of member information, with particular emphasis on capturing changes in enrollment, plan levels, and low-income subsidy status.
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Text version
Report Cover
| Exhibit 28: MAPD File and Changes Reports |
| [Supplier Name] |
| OEIBA Program |
| [Date] |
| Report | Report Title | Tab Name |
| 28a | MAPD Disenrollment and Changes | MAPD Changes |
| 28b | MAPD Full File | MAPD Full |
Note: Completed template must be submitted electronically as an Excel file uploaded to the EGID sftp website.
28a MAPD Changes Due Date Wednesday following the week being reported
| MAPD Disenrollment and Changes |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
SSN First Name Middle Name Last Name Member ID Effective Date Term Date Date of Death HICN Plan Option LIS% LIS Effective Date LIS Term Date Enrollment Successful (Y/N) Reason for Unsuccessful Enrollment
| *Electronic file or spreadsheet indicating disenrollments and changes processed in the MAPD’s system along with any change in the low income premium subsidy. |
| Instructions: |
| 1) For new enrollments, the effective date is the date coverage begins |
| 2) Term Date for disenrollment is the date coverage ends |
| 3) Date of Death, if applicable |
| 4) HICN: Medicare Claim Number |
| 5) Plan Option: For MAPDs that have two or more different plans (e.g., High or Low) |
| 6) LIS% (100%, 75%, 50% or 25%) is the low income subsidy percentage as established by CMS (if applicable) |
| 7) LIS Effective Date is the date LIS begins |
28b MAPD Full Due Date 10th of the same month
| MAPD Full File |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
SSN First Name Middle Name Last Name Member ID Date of Death HICN LIS Level Plan Level
| Notes: |
| 1) Listing all members enrolled in the MAPD as of the first of the month |
| 2) Plan Level (high vs. low, if applicable) |
| 3) Date of Death, if applicable |
File details come from the government source that posted it. Updated .