Audit of Medicare Part D Eligibility Verification Transactions

OBJECTIVE

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.

TIMELINE

• July 20, 2022
  Announced
• December 19, 2024
  Complete

  Audit of Medicare Part D Eligibility Verification Transactions has been marked as complete. Report Published

REPORT PUBLISHED

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