Omb 0938 1013 form-2026

The document provides detailed instructions for entities required to disclose their prescription drug coverage status to the Centers for Medicare & Medicaid Services (CMS) under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. It outlines the definition of 'creditable coverage,' the entities obligated to submit disclosures, the timing and method for submission, and specific steps to complete the online Disclosure to CMS Form. The document emphasizes compliance with regulations and includes guidance on how to report changes in coverage status.

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Click ‘Get Form’ to open the omb 0938 1013 form in the editor.
Begin by entering the required entity information in Box A, including the name, federal ID number, and address.
Select the type of coverage offered and indicate how many prescription drug options are available.
Choose whether all options are creditable, non-creditable, or a mix. Complete the relevant boxes (B, C, or D) based on your selection.
Fill in the plan year dates and provide estimates for Medicare Part D eligible individuals covered under each option.
Review all entered information for accuracy before proceeding to submit your disclosure.
Click ‘Submit’ to finalize your disclosure. Ensure you print a confirmation page for your records.

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How to submit to Medicare Part D?

You can enroll in a Part D plan in several ways: on the medicare.gov website, by calling a Part D plan directly, or. by calling 1-800-MEDICARE.

Who submits Medicare Part D claims?

Medicare drug plan (Part D) , the pharmacy will file a claim directly with your plan.

Who do I contact for Medicare Part D?

Call us at 1-800-MEDICARE (1-800-633-4227). Help from Medicare is available 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048.

Who do I send Medicare Part D notices to?

The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form. Reimbursement requests may be submitted up to 36 months from the date of service.

What is the penalty for not sending Medicare Part D notice?

There are no specific penalties for employers that fail to comply with the Medicare Part D disclosure requirements, except for employers that are claiming the Retiree Drug Subsidy. However, by not providing creditable coverage disclosure notices, employers may trigger adverse employee relations issues.