Retroactive
Enrollment & Disenrollment

Task Activities

This page is designed to provide a reference for Medicare Advantage Organizations (MAOs), formerly known as Medicare+Choice Organizations (M+CO), to submit retroactive enrollment / disenrollment requests to IntegriGuard.

IntegriGuard processes retroactive enrollment and/or disenrollment requests from a specific MAO. Requests are received from various sources, including Medicare beneficiaries, MAOs, the Social Security Administration, and the Railroad Retirement Board. IntegriGuard utilizes various CMS systems to process these requests.

Submission of Retroactive Requests

Electronic Submittal

Medicare Advantage Organizations may submit retroactive requests electronically. An Excel spreadsheet has been developed for each category using Visual Basic code to assist you in making sure that the data is submitted in the appropriate format. In order to take advantage of this process, please register to receive the tool kit .

Other Means of Submittal

Data may also be submitted to IntegriGuard on CD or diskette. The format and required fields are shown under each status category listed below. It is very important that all elements listed are provided in the format requested. This is particularly important when submissions are processed electronically.

Redeterminations

As part of the system implemented to process these adjustments, IntegriGuard has developed a procedure by which an MAO may ask IntegriGuard to reconsider determinations that are made.

Standard Operating Procedures

IntegriGuard will follow the Standard Operating Procedures (SOP) that are in place at the Centers for Medicare & Medicaid Services (CMS) for the completion of all retroactive adjustments.