Vendor Management, Payments, and Collections (VMPC) FAQ
Guidance for FAQ regarding Payment Processing and Other
Program Area: Vendor Management, Payments, and Collections (VMPC)
Question: Please define effectuated enrollment group and effectuated enrollment and explain how an effectuated enrollment differs from a confirmed enrollment.
Answer: For the purposes of the interim payment process, the Centers for Medicare & Medicaid Services (CMS) defines an effectuated enrollment group as any enrollment group in which the enrollment group has paid in full the amount of the total premium for which they are responsible. The 834 enrollment transaction lists the amount for which the enrollment group is responsible as the REF01 value for TOT RES AMT as listed in the 2750 loop. CMS will consider effectuated enrollments confirmed as indicated by the submitter and make payments based on Enrollment & Payment Data Template submissions.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 06, 2013
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