CMS Pub. 100-16, ch. mc86c17d, § 30.2.1

A Medicare beneficiary’s enrollment begins on the first day of the month in which his or

her membership in the cost plan is effective, as shown on CMS records. The effective

month of coverage may not be earlier than the first month after, or later than the third

month after, the month in which the enrollment information is correctly submitted to and

received by CMS. The CMS may approve a later effective date if requested by the plan

and the beneficiary.

Enrollment cannot be effective prior to the date entitlement to Medicare Part A and Part

B, or Part B only begins.

The cost plan is responsible for submitting accurate and timely records to CMS for new

enrollments. The CMS is responsible for promptly supplying written verification of the

individual’s acceptance (or rejection) in the plan. Generally, CMS does not accept

records received after the monthly cut-off date for submission of records (as announced

by CMS periodically), or that are incomplete or incorrect.

Enrollment Effective Date Example:

The CMS monthly cut-off date for the submission of records is August 14,

2002. A cost plan enrollment application form that is received on

August 12, 2002, could have an effective date of enrollment of

September 1, October 1, or November 1, 2002.

If the same cost plan enrollment application form was received on

August 15, 2002, (i.e., after the cut-off date for the submission of records)

it could have an effective date of enrollment of October 1, November 1, or

December 1, 2002.

If the cost plan has informed a beneficiary that his/her enrollment in the plan is effective

on a certain date, but then submits an incorrect enrollment record to CMS, the plan must

honor its contract with the individual and begin providing coverage on the stated date. If

the plan provides services to the member before it can submit the correct enrollment

information, the plan may still receive Medicare fee-for-service payments for any

services it renders. In order for the cost plan to receive direct payments for physician and

supplier services from a Medicare carrier, the cost plan must have a third party billing

number, or it can have the physician or supplier directly bill the FFS program.

Additionally, if the cost plan collects or has waived collection of a premium from the

beneficiary which covers the deductible and coinsurance for Medicare covered services

for the originally designated month of enrollment, the cost plan is financially responsible

for Medicare deductibles and coinsurance amounts not paid by carriers and

intermediaries on pre-enrollment claims for services obtained in network or for

emergency or urgently needed care. The Medicare beneficiary is liable for any services

for which the cost plan has no financial responsibility under the terms of its Medicare

contract.