Managed Care Toolkit

 

Thank you for visiting our Web site to obtain information regarding submitting retroactive change

requests to IntegriGuard. The following listing of linked information will help us work together.

n the description of each item, we identify which items pertain to the following types of

organizations: MAs, MA-PDs, PDPs, Cost Plans, Demo Plans, and PACE Plans.

Please submit a summary of your requested changes on our automated Excel spreadsheet, via a

CD, so we can upload your data into our system. This allows us to track your requests and

provide you a status of your requests in a standard format using disposition codes.

Please remember: You cannot send Excel spreadsheets electronically due to HIPAA.

 

To obtain a downloadable version of an Excel spreadsheet to submit requests to IntegriGuard for

all categories, click on:

IntegriGuard Electronic Submission Spreadsheet [Excel]

 

To obtain definitions of codes found on IntegriGuard Final Disposition Reports, click on:

Definitions of Codes on Final Disposition Reports [PDF]

 

To obtain a checklist and cover page to assist in filing required documentation with requested

Enrollment/Disenrollment/PBP changes, click on:

Retroactive Enrollment/Disenrollment Cover Page and Checklist [Word doc]

Retroactive Adjustment Requests: Chapter 19 of the Managed Care Manual includes Standard

Operating Procedures (SOP) with detailed information concerning retroactive adjustment

requests. For the convenience of those organizations submitting requests for retroactive

adjustments, we have separated the sections that apply to particular items. Just click on any of

the links below the descriptions to download sections.

 

To obtain submission instructions and SOPs for Enrollment and Disenrollment change request,

click on:

Retroactive Enrollment Disenrollment Submission Process and SOP [PDF]

 

To obtain submission instructions and SOPs for SCC change requests, click on:

SCC Status Changes Submission Process and SOP [PDF]

(Please note: These are not address changes. These requests change the SCC used in the

payment calculations only. Organizations can change the address in the MBD themselves.)

 

To obtain submission instructions and SOPs for Institutional change requests, click on:

Institutional Status Changes Submission Process and SOP [PDF]

 

To obtain submission instructions and SOPs for Medicaid change requests, click on:

Medicaid Status Changes Submission Process and SOP [PDF]

 

To obtain submission instructions and SOPs for End-Stage Renal Disease (ESRD) change requests,

click on:

ESRD Status Changes Submission Process and SOP [PDF]

Additionally, the following linked CMS guidelines may assist you in preparing and submitting your

retroactive requests.

 

To obtain the Medicare Managed Care Manual: Chapter 2, click on:

Chapter 2 - MA Enrollment Guidance Update

 

MMC Manual Chapter 19 Standard Operating Procedures SOP is being updated. When it is back on

the CMS Web site, we will publish the link.

 

To obtain PDP guidance, click on:

PDP Enrollment Guidance Update

 

Thank you again for your interest. Please feel free to contact us with questions or assistance.

Sincerely,

Retroactive Payment Validation Task Order Contract

IntegriGuard, LLC

'Program integrity. Payment accuracy.'