CMS Pub. 100-22, ch. 3, § 30

Program

(Rev. 11, Issued: 03-26-13, Effective: 06-25-12, Implementation: 06-25-12)

The Medicare contractors will receive recurring update notification change requests for eRx incentive

payments. For additional information on this program, see Chapter 2 of this manual.

Contractors shall make the eRx incentive payments to a group practice, or individual for a private practice,

associated with the Tax Identification Number (TIN) identified on the eRx Incentive Payment file. There

will be an annual payment file, developed by a CMS specialty contractor, containing the following

information:

• EP Contractor Number

• EP Tax ID Number

• EP Incentive Amount

• Incentive Report Start Date

• Incentive Report End Date

The CMS specialty contractor shall include a header record on the payment file to identify the type of

incentive file and reporting period. RX denotes eRx. The file transfer process is as follows: (1) The specialty

contractor shall transmit the Incentive Payment file to the CDS and HP EDC in Extended Binary Coded

Decimal Interchange Code (EBCDIC); (2) MCS shall segregate the Incentive Payment file MAC/carrier

workload number and load into the appropriate instance of MCS; (3) Contractors shall retrieve the file upon

direction from CMS after the file is available at the datacenter.

The time frame that Medicare contractors have for completing the eRx Incentive payments is approximately

thirty calendar days. The exact payment beginning and end dates will be in the recurring update notification.

There are 4 possible payment months each year: May, August, September, and October. CMS shall add, at

its discretion, up to (1) one extra payment cycle per payment year. The Carrier/MACs will be notified via a

recurring update notification change request which month the respective incentive payments shall be made.

Also, there is the potential for a supplemental payment file that could be provided at a later date, if CMS

determines a need for making a supplemental payment. If needed, a supplemental payment would be made

in one of these 4 payment months.