CLAIMS PROCESSING/TrOOP

Participants will learn that in order to administer Part D, they have to differentiate what is and is not part of TrOOP. There will be a discussion about payments paid by beneficiaries as well as payments made by third party payers on behalf of beneficiaries that count toward TrOOP. There will also be a discussion of how low-income cost sharing counts toward TrOOP. Participants will walk through a scenario where payment was made by a beneficiary, friends, and family, where the beneficiary has low-income cost sharing. The facilitator will discuss the fields associated with TrOOP, the catastrophic coverage flag, drug coverage status flag, and the five payment fields.