Nationwide Audit of Medicare Part D Eligibility Verification Transactions
An E1 transaction is a Medicare Part D eligibility verification transaction that the pharmacy submits to the Part D transaction facilitator to bill for a prescription or determine drug coverage billing order. The Part D transaction facilitator returns information to the pharmacy that is needed to submit the prescription drug event. E1 transactions are part of the real-time process of the Coordination of Benefits and calculating the true out-of-pocket costs (CMS, Medicare Prescription Drug Benefit Manual, Pub. No. 100-18, chapter 14, § 30.4). We will review CMS's oversight of E1 transactions processed by contractors and determine whether the E1 transactions were created and used for intended purposes.
|Announced or Revised||Agency||Title||Component||Report Number(s)||Expected Issue Date (FY)|
|Revised||Centers for Medicare & Medicaid Services||Nationwide Audit of Medicare Part D Eligibility Verification Transactions||Office of Audit Services||W-00-20-35751||2023|