EMMA Terminology

Question 1

Application

Answer 1

Used to describe the system as a whole

Question 2

Authenticating

Answer 2

Logging into the system

Question 3

Navigation Drawer/Headings

Answer 3

Accessing the different menus in EMMA

Question 4

Navigation Menus

Answer 4

Combination of Headings and subscreens that allows the user to search for specific processes worklists or conduct administration within an individuals record

Question 5

MBIT

Answer 5

An individual transaction record for a member. The system automatically sends an MBIT file (member record transaction) daily to CMS that includes transactions that have been added throughout the day and sent as a batch. The term MBIT is used when this file is sent to CMS.
MBITs are generated automatically by the system or can be generated manually by a user

Question 6

Pending MBIT

Answer 6

Indicates a residential Address update was generated by the system and requires approval for inclusion in the MBIT submission

Question 7

Worklist

Answer 7

A particular section or process queue within EMMA that has designated break outs of the elements of the member records life cycle

Question 8

View Contact

Answer 8

The list of all current membership with UPMC For Life. A contact in EMMA represents an individual person. This person may have multiple attributes associated to them notably their demographic information as well as many sets of transactional data such as membership spans

Question 9

Contact Details

Answer 9

The member record that includes all of the members details from plan information, demographic information, primary care physician information, notes, etc

Question 10

IEQ

Answer 10

The real-time data fed over from CMS to EMMA that populates the beneficiaries medicare eligibility information

Question 11

Benefit Span

Answer 11

A benefit span represents the collection of a series of attributes over a period of time. These attributes are:
Membership data – Group ID, Subgroup, Plan Code, Contract, PBP, Effective Date
Rider – PACE, PACENet, ADAP, ADAP Part C, or SPDAP change
Miscellaneous Status Code
Medicaid
Disability
Hospice
Institutional
ESRD/Transplant/Dialysis
MSP
Premium Withhold Option
Low Income Subsidy Level/Copay Category
Permanent or Mailing Address
QMB/SLMB (any time dual code changes)
VBID/ IC Model Span Status
Any time one of these attributes changes it creates a new benefit span. The span represents a contiguous period of time within a given membership where all of these data attributes were the same. Note that a membership may contain multiple benefit spans but every day of a membership must be included within a benefit span. This concept may or may not be used downstream for claims processing

Question 12

Table View

Answer 12

A number of features to ease navigation. The results delivered from a search can be sorted from ascending to descending

Question 13

Contact History

Answer 13

Tabs within the Contact Details screen that allows the user to perform member maintenance functionality on a specific membership

Question 14

Contact Edit

Answer 14

An edit “pencil” button located within the Contact Details screen in the demographic information container that contains fields for the editing of demographic information as well as a history section at the bottom to view/edit contact data that exists over spans of time

Question 15

CMS Enrolled

Answer 15

Active Status

Question 16

CMS Disenrolled

Answer 16

Terminated; indicates that the member is no longer a member of the plan due to being disenrolled and that disenrollment has been accepted by CMS (or possibly originated from CMS via the TRR file). The actions available are:
View Enrollment Application
Send Letter Request
Reinstate Member
Manual Membership Edit

Question 17

Pending Enrollment/No MBIT Sent

Answer 17

Similar to Complete as application status/Pending as membership status
EMMA breaks out “pending” and “pending no MBIT sent” because it creates a contact record after the application is saved

Question 18

Pending Enrollment-No MBIT Sent

Answer 18

This status indicates that an enrollment has been submitted and was considered complete but has not yet been exported to CMS via the MBIT file. When a membership is in this status the available actions are:
View Enrollment Application
Send Letter Request
Plan Deny Enrollment
Plan Cancel Enrollment
Manual Membership Edit

Question 19

Pending Enrollment - MBIT Sent

Answer 19

Indicates that an enrollment has been submitted and was considered complete and the record has been exported to CMS via the MBIT file. At this time EMMA has not received an acceptance transaction from CMS for the enrollment on a TRR file. When a membership is in this status the available actions are:
View Enrollment Application
Send Letter Request
Cancel Enrollment
Manual Membership Edit

Question 20

Pending Enrollment-Incomplete

Answer 20

Incomplete Enrollments were submitted but it was determined that the application is missing necessary information to process and submit to CMS. The actions available when a membership is in this state are:
View Enrollment Application
Send Letter Request
Manual Membership Edit

Question 21

CMS Enrolled

Answer 21

CMS Enrolled is the status used for current active members. This indicates that EMMA received an acceptance of the enrollment and the member is actively receiving benefits. The available actions for these members are:
View Enrollment Application
Send Letter Request
Disenroll Member
Manual Membership Edit

Question 22

CMS Disenrolled

Answer 22

CMS Disenrolled status indicates that the member is no longer a member of the plan due to being disenrolled and that disenrollment has been accepted by CMS (or possibly originated from CMS via the TRR file). The actions available are:
View Enrollment Application
Send Letter Request
Reinstate Member
Manual Membership Edit

Question 23

Enrollment Cancelled

Answer 23

This is the status of a membership where the pending enrollment was cancelled or plan cancelled. Actions available are:
View Enrollment Application
Send Letter Request
Manual Membership Edit

Question 24

Plan Cancel Enrollment

Answer 24

Cancellation of application before MBIT is sent to CMS

Cancel Enrollment: CMS has member pending and cancellation request is sent after the MBIT was accepted by CMS

Question 25

Enrollment Denied

Answer 25

This is the status of a membership where the pending enrollment was plan denied. Actions available are: View Enrollment Application Send Letter Request Manual Membership Edit

Question 26

Enrollment Rejected

Answer 26

Memberships in this status were rejected after being submitted to CMS via the MBIT. The rejection was received on the TRR file. Available actions are: This is the status of a membership where the pending enrollment was cancelled or plan cancelled. Actions available are: View Enrollment Application Send Letter Request Plan Deny Enrollment Manual Membership Edit

Question 27

Closed

Answer 27

The Closed status is only used to manually update a membership to reflect closed. This is generally done to correct an error. Available actions are: View Enrollment Application Send Letter Request Manual Membership Edit

Question 28

Closed - Annual Rollover

Answer 28

This status appears on a membership as part of the Annual Rollover process (covered in more detail later in this guide). Upon completion of a rollover from the current year to next year’s plan the status of the prior enrollment is set to Closed - Annual Rollover. Available actions are: View Enrollment Application Send Letter Request Manual Membership Edit

Question 29

Closed - Plan Changed

Answer 29

This status will appear on a membership record when the member performs a plan change. Because the product is being changed, a new membership span is created. The prior membership will reflect this status. Available actions are: View Enrollment Application Send Letter Request Manual Membership Edit

Question 30

Pending Disenrollment- No MBIT Sent

Answer 30

``` This status is similar to the Pending Enrollment - No MBIT Sent but for members who are currently enrolled and are in the process of being disenrolled. These members have had a disenrollment created on their record but the transaction has not been sent to CMS via the MBIT file. The available actions for these members are: View Enrollment Application Send Letter Request Plan Deny Disenrollment Plan Cancel Disenrollment Manual Membership Edit ```

Question 31

Pending Disenrollment - MBIT Sent

Answer 31

``` These members have a disenrollment created on their record and the MBIT transaction has been sent to CMS. The actions available for them are: View Enrollment Application Send Letter Request Cancel Disenrollment Manual Membership Edit ```

Question 32

Plan Cancel Disenrollment

Answer 32

Occurs when the beneficiary requests to disenroll and the MBIT has not been accepted

Question 33

Cancel Disenrollment

Answer 33

The request to cancel the disenroll is sent after the disenrollment MBIT transaction was accepted by CMS.

Question 34

Pending Reinstatement

Answer 34

``` Members who are Pending Reinstatement were disenrolled at one point but have an active reinstatement request that has not yet been accepted or denied. EMMA does not differentiate between Reinstatements MBIT sent vs. No MBIT sent like it does for enrollments and disenrollments as these are generally processed through the retroactive case processor. The available actions for these members are: View Enrollment Application Send Letter Request Deny Reinstatement Cancel Reinstatement Accept Reinstatement Manual Membership Edit ```

Question 35

Pending - Annual Rollover

Answer 35

This status indicates a given membership is currently active but the rollover process has begun. The expectation is that the membership will remain open until the beginning of the new year at which point the new membership span will be activated and this span will be closed. Available actions are: View Enrollment Application Send Letter Request Manual Membership Edit