Compliance Corner: Accuracy of Eligibility Applications
When completing eligibility applications, it is important to confirm all information (including attestations) with the consumer before submitting, to ensure accuracy. A record of this confirmation should be documented, in addition to the documented consumer consent that must be obtained prior to assisting the consumer.
Please note:
- The consumer consent is separate from the confirmation of accuracy and must be documented prior to assisting with or facilitating enrollment in an Affordable Care Act (ACA) plan
- You must retain copies of both and be able to produce the documentation upon request
- Consumer consent documentation must be current and confirmation of accuracy must be obtained every time an action is taken to change or update a consumer’s eligibility application or plan selection
- Agents, brokers and web-brokers must never change a consumer’s eligibility application information or plan selection without documenting that the consumer consented to the change and has confirmed that the information is accurate
- Consumers may revoke consent at any time and may choose to work with another agent or broker without rescinding their original consent
- If you notice changes on a consumer’s eligibility application that were not made by you, do not adjust the application. You must check with the consumer first, to see if the changes were authorized
Although the Centers for Medicare & Medicaid Services (CMS) does not provide specific direction on how the consent or confirmation of accuracy should be documented, brokers and agents are responsible for documenting and retaining both for a minimum of 10 years – whether they are in the form of signed paper or electronic documents, email or recorded verbal consents.
For more information about CMS consent and confirmation of accuracy requirements, click the button below.
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