Understand CMS Interface

The Centers for Medicare and Medicaid Services interface provides information about Medicare Part D enrollment and plan information as well as Medicare Part A and B eligibility.

Select the CMS icon from the Interfaces Menu.
The CMS List window will display the date a record is received from CMS and the record month and year. Highlight the appropriate record line and select the Demographics button.
The CMS Demographic Detail window will display. This window contains the demographic data CMS has for the person. Please note: some pharmacies require the client's date of birth match both N-FOCUS and the CMS file. The client will need to contact SSA if the CMS file is incorrect.
Select the Ok button to return to the CMS list window.
Select the Part D Enrollment button. The CMS Part D Enrollment Detail window will display. The Enrollment History box displays the Start and End dates of enrollment, Company and Plan name and Enrollment type (scroll to the right to see Enrollment Type).
The Part D Copay History box displays the Copay Level information assigned by CMS. The Low CoPay is $1 or $3; the High CoPay is $2 or $5. Select the Ok button to return to the CMS list window.
Select the Part A/B Enrollment button. The CMS Part A/B Enrollment Detail window will display. This window provides information about Part A and B enrollment and premium payer. Select the Ok button to return to the CMS list window.

Note: In order for Medicare Part B buy in to occur, demographic data in N-FOCUS must match the CMS file. Now that CMS data is available, you may compare the two files to assist in a successful buy in process. If name, SSN, sex, or date of birth data differs in any area, Medicare Part B buy in will not occur. If N-FOCUS data is incorrect, make the necessary corrections. If the CMS data is incorrect, the client or representative will need to contact the Social Security Administration to get this corrected.

Additional Note for Railroad Retirement Benefits: The CMS File claim number shown on the Part D enrollment window is a number created by CMS and used only by CMS. Do not change the Medicare claim number to this, as it will adversely affect MMIS information. Since the number is not known to N-FOCUS, it will not transfer to MMIS, and no eligibility will show for the client.