IntegriGuard, LLC

Managed Care Toolkit

In each item's description, 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.