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• If the enrollment request contains all required information (noted in Appendix 2).

The plan verifies Medicare entitlement using CMS systems (i.e., the Batch Eligibility Query (BEQ) or the MARx online query), except for enrollment requests from a current enrollee switching to another plan offered by the same parent organization. Individuals are not required to provide evidence of entitlement to Medicare Part A and/or Part B with the enrollment request. If the enrollment request does not include the individual’s Medicare Number and the plan is unable to locate the individual in the BEQ or MARx online query (or the plan’s own files, in the case of a current enrollee switching to another plan offered by the same organization), the organization should consider the enrollment request incomplete and follow the steps outlined in § 50.3.

The plan is also responsible for determining the election period of each enrollment request. The plan can:

• Incorporate specific statements regarding eligibility for an election period with the enrollment or disenrollment request (see Exhibit 1a for optional use with enrollment mechanisms).

• Contact the individual (by phone or other communication mechanism) if the enrollment period cannot be determined from the information provided in the enrollment request.

The plan must not immediately deny an enrollment request that does not have all necessary elements required to consider it complete. If the enrollment request is incomplete, the plan must follow the procedures outlined in § 50.3 in order to complete the enrollment request.

If all plan eligibility and enrollment requirements are not met after being reviewed against CMS systems, the individual is determined ineligible, and the organization must deny the enrollment (see § 50.4 for notifying the individual).

50.3 – Incomplete Enrollment Requests 42 CFR §§ 422.50(a)(5), 423.30, and 423.32

When the enrollment request is incomplete, the plan must:

• Document its efforts to obtain information needed to complete the enrollment request. • Check if the required but missing information can be obtained via CMS systems; and, if not, • Notify the individual (in writing or orally) within 10 calendar days of receipt of the enrollment request that additional information is needed.

NOTE: To obtain information to complete the enrollment request, the plan may contact the individual in writing or by telephone. If the contact is made by telephone, the plan must document the contact and retain the documentation in its records. The plan must explain to the individual that they have 21 calendar days in which to submit the missing information, or the enrollment will be denied.