1. Offeror shall maintain and ensure compliance with the Voluntary Data Sharing Agreement (VDSA) with the Centers for Medicare and Medicaid Services (or other means of providing required services). 2. Through VDSA (or other processes to be proposed), offeror will identify all participants, eligible for Medicare in any plans offered by the Department. Information should include date of Medicare eligibility and enrollment in Parts A, B and D, the reason for eligibility, and the End Stage Renal Disease (ESRD) coordination period, if applicable. This will be used to ensure appropriate Medicare primacy and to provide Medicare Part D Creditable Coverage Notices to Medicare- eligible active plan participants. Data shall be available in an Excel spreadsheet format, within a week of receiving the file from Center for Medicare & Medicaid Services (CMS) or other means of identification. 3. Offeror shall work with claims administrators to retract primary payments made in error due to the failure in timely moving participant to Medicare-primary coverage status. Offeror will also coordinate with health care plan to re-file claims with Medicare per program provisions and within Medicare time limits. 4. Offeror shall resolve any IRS/SSA/CMS Data Match requests generated in error. 5. Offeror shall monitor activities of all entities associated with Medicare coordination of benefits, to ensure that the Commonwealth of Virginia Health Benefits Program is in compliance with Medicare Secondary Payer (MSP) processes, and offeror should keep the Program informed of any changes affecting the process. 6. Offeror shall work with the CMS, Medicare Secondary Payer (MSP) Recovery administrator, the DHRM, health plans, and other related entities to ensure that Primary Payment Notices and Medicare Secondary Payer Demands are sent to the Department of Human Resources Management (DHRM), as plan administrator, and not to individual state agencies. 7. Offeror shall assist Medicare-primary participants, who have failed to enroll in Medicare Part B with a Disability Special Enrollment. Offeror shall eliminate or reduce any premium surcharge/penalty and allow for filing of claims for primary Medicare coverage. 8. Offeror shall respond to and resolve Medicare Secondary Payer Demand Letters Intents to Refer to the Department of Treasury and subsequent collection activities, on behalf of DHRM, other state agencies, and localities also enrolled in DHRM programs. This shall also include developing a process for responding to Primary Payment Notice requests. 9. Offeror shall be able to administer a program to identify participants who may be eligible for Social Security disability, assist with participant applications, and ensure that Medicare becomes the primary payer immediately upon eligibility. 10. Offeror shall be able to identify enrolled participants in any health plan offered by the Department who is deceased, including the date of death. 11. Offeror shall adhere to the Commonwealth Information Security Standard SEC- 501.
