Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 31, 2017

Program Area: Enrollment and Eligibility (ENR)

Question: When did the Centers for Medicare & Medicaid Services (CMS) publish guidance on the Federally-facilitated Marketplace (FFM) sending the approved resolution for an appeal via an IC834 transaction?

Answer: During the week of July 24th 2017, the CMS Appeals Center began using the Special Enrollment Period (SEP) Date Picker for retroactive effective dates. The SEP date picker will generate an IC834 transaction. As a result, HICS cases will only be required for these scenarios: - To convey a mid-month effective date, e.g., a newborn - To convey instructions for implementing eligibility pending appeal CMS notified issuers of this Appeals update on May 22, 2017 during the Enrollment and Eligibility Bi-weekly Issuer Call Series IX Webinar. The complete guidance on 'Enrollment Appeals Date Picker for Retroactive Coverage' can be referenced here: https://www.regtap.info/uploads/library/ENR_ApplDcsnImplmnttnChngs_052217_5CR_061417.pdf

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