CMS provides state Medicaid agencies with multiple data exchanges to support coordination and program operations for people who are dually eligible for Medicare and Medicaid.
These data exchanges include:
These data exchanges are covered by an Information Exchange Agreement (IEA) and accompanying Data Request and Attestation (DRA) form. For more information on these agreements, please visit the Data Agreement Page.
CMS is modernizing Medicare Enrollment & Premium Payment Systems legacy applications to a modern, cloud-based architecture. These changes will improve the quality of services to Medicare beneficiaries, improve information security, reduce costs, and improve operational efficiencies. Part of this effort includes a shift from the Enrollment Database (EDB) State File Exchange to the Territory & State Beneficiary Query File (TBQ) by June of 2022. To aid in this transition, CMS hosted a webinar to discuss the retirement and transition process and next steps.
This document provides information on the elements of the Medicare Enrollment Database (EDB) and how these elements link to the elements of the Territory Beneficiary Query (TBQ) file. This EDB-TBQ Crosswalk will help your state transition to using the TBQ File.
If you are looking for additional information, please be sure to contact us.
This overview document focuses on the following four CMS data files to provide the similarities and differences between each:
This document also provides resources and the Centers of Medicare and Medicaid’s contact information. If you are looking for additional information, please be sure to contact us.Download Overview File
Medicaid programs help pay for Medicare premiums and, in some cases, Medicare cost-sharing, for certain low-income adults over age 65 and people with disabilities. All states, D.C., and some U.S. territories have entered into Part B state buy-in agreements with CMS to pay Part B premiums for those receiving Supplemental Security Income (SSI) and other cash assistance, those enrolled in the Medicare Savings Programs (MSPs), and certain other Medicaid coverage groups. Most states have expanded their buy-in agreements to include the payment of Part A premiums for Qualified Medicare Beneficiaries (QMBs).
State buy-in agreements simplify the process for states to assist low-income residents with Medicare expenses. Buy-in agreements permit states to directly enroll eligible individuals in Medicare Part A and/or B at any time of the year, without regard for Medicare enrollment periods, and to pay premiums on their behalf, without any late enrollment penalties. For an individual who is determined eligible for Medicare by SSA, but not enrolled, state buy-in works to enroll the individual in Medicare Part A or Part B and to direct the federal government to bill the state for the enrollee’s premiums. For an individual who is already enrolled in Medicare, state buy-in directs the federal government to bill the state for the beneficiary’s Medicare premiums and stop collecting the premiums through deductions from the beneficiary’s monthly Social Security, Railroad Retirement Board (RRB), Office of Personnel Management (OPM) benefits, or through CMS direct billing.
State Buy-in File Data Exchange
State buy-in of Medicare premiums for dually eligible individuals operates through an established data exchange process between the state, CMS, and SSA. States depend on the successful transmission of accretion, deletion, and change records to effectively update states’ roles for their MSPs. In turn, CMS will update all records through the CMS Third Party System (TPS) and return a response file to inform the state about the disposition of each record. CMS returns a rejection notification when a state’s request fails to update through TPS processing.
This data exchange is covered by an Information Exchange Agreement (IEA) and accompanying Data Request and Attestation (DRA) form. For more information on these agreements, please visit the Data Agreement Page.
Webinar: Overview of the Buy-In File Exchange.
To learn more about the Buy-In File Exchange and the benefits of daily submission for your state, watch our recent webinar (left):
To download a copy of the slides, please click on the button below.Download Slides Here
The Buy-In Tip Sheet provides best practice and system tips about the CMS Buy-In File. This new resource also answers common questions on the Buy-In File, ranging from testing daily exchange to transaction codes and processing times.Download Buy-In Tip Sheet
On September 8, 2020, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”). The manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid.Access Website Here
To learn more about the MMA exchange file offered by CMS, click below.Visit MMA Information Page
To learn more about the files encompassed under the Medicare-Medicaid Data Sharing Program, click below.Download Data Sharing Overview
To learn more about the MMA, Buy-In, TBQ, and EDB exchange files offered by CMS, click below.Download CMS Data Overview
You are leaving the SDRC Public website and are being redirected to the new SDRC Portal website, where you can submit and track data requests, ask questions, and access SDRC resources. You will need a username and password to log into the SDRC Portal. If you are Medicaid agency staff and/or associated downstream user who would like access, please contact the SDRC Support Team for more information.