True ups

[policywunk]

I looked at my UHC true ups statement today and was paid true ups on a few AEP members who were on pdp plans but had been enrolled in a MA plan in the past .I thought we weren't getting paid full true ups on these cases anymore?

 

[Russ]

CMS can't keep things straight. I got paid true-ups with Humana that shouldn't have been.

 

[selfgen]

I’m not familiar with this term “ true ups “. Anyone care to enlighten me?

 

[Todd King]

I’m not familiar with this term “ true ups “. Anyone care to enlighten me?

When you enroll someone into a Medicare Advantage Plan, you get paid the equivalent of the renewal amount (this year it is $301). If the enrollee has never been on an MA plan, you will get paid the full $601. However, you won't get all of it right off. When CMS checks to see if the enrollee has never been on an MA plan, then they will authorize the company to pay you the rest, which is called a "True Up".