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Medicare Policies, Commission Distribution, and Transactions

Medicare Policies, Commission Distribution, and Transactions

Policies

The Policy detail page for MEDICARE and non-MAPD are the same, except that the Premium fields are not needed and can be left as $0.00. When the Policy is for a Medicare Advantage or Medicare Prescription Product Type, the Commission Distribution for the Policy is different.

Policy detail page with link to Commissions (Commission Distribution) outlined

Commission Distribution

The Commission Distribution holds the hierarchy of Agents and their associated rates for a Policy. It is set in a Policy during close of its first Commission Cycle or if it is edited and saved. When the system creates a Commission Distribution for a Policy, including MEDICARE Policies, it will consider any Alternate Contracts or Alternate Upline values from Custom Settings. Commission Distributions can also be created or updated with the import ‘Policy Commission Distribution MAPD & PDP.’

 Policy List page – line options highlighting option to access Commission Distribution 

Commission Distribution page when Policy is MAPD or PDP Product Type

When editing a Commission distribution from the UI, rate amounts can be editing by changing values. Agents can be added by selecting Add Agent/Organization. Reset can also be used to use current values for Agent Hierarchy, Agent details or settings, and Commission Rates, to make the Commission Distribution.

Edit commission Distribution page with Rest, Add Agent/Organization, and new lines for an added Agent outlined

Commission Distribution Report

There is a ‘Policy Commission Distribution MAPD & PDP’ report. This can be used to export the Commission Distribution within Policies, and then if needed, the export can be updated and imported to make changes.

This report for MAPD/PDP only displays Policies for Policies with the two Medicare Product Types. The non-MAPD version of the Commission Distribution report will not display Policies for Medicare Product Types because of the differences in the rates.

Policy Commission Distribution MAPD & PDP Report:

Transactions

Transactions can be accessed in two locations. One is the Transaction list page that shows Transactions across all policies. Since the data is different between MEDICARE and non-MAPD, there are separate tabs for each. If there are only transactions of one type for the status type(s) in the filter, then only one tab will be displayed. The other location is when transactions are accessed from a Policy where only Transactions for that Policy are displayed. The transactions viewed via a Policy will confirm to the Product Type of the Policy, so if MEDICARE, it will display the fields needed for the Street and Override fields.

Fields in a Transaction

These fields are displayed when the transaction is being created or displayed from the Transaction History page that covers all policies.

  • Policy Number
  • Policyholder
  • Issuer

These next fields are in transaction detail displays from either location used to access Create or Edit transactions:

  • Transaction Date – the date must be on or before the Commission processing date used in a cycle to be picked up for calculations. Typically, the date entered will be the date of the next cycle’s processing date.
  • Transaction Status – read only field for the status. For MEDICARE Policies that do not have the Street/Override fields populated to match the Commission Received amount, the status will be Unallocated. When the Street/Override fields have been populated correctly, the status will be Open, and the transaction can be picked up and processed within a cycle. Once a transaction is in a cycle that has not been closed, referred to as an ‘open cycle,’ then the status of the transaction will be Pending. If changes need to be made to one in pending status, the open cycle will be abandoned, the transaction will revert to Open, and the cycle will need to be run again. After a cycle is closed, the status in the transaction will be changed to Processed.
  • Commission Received – This is the amount indicated in the Carrier Statement of the total amount paid. Unlike non-MAPD policies, it is a required field as it will drive the Commissions calculated.
  • Street Initial – amount for the Writing Agent for the Initial payment for the year.
  • Street True-up – amount for the Writing Agent when CMS confirms a customer who has never had Medicare before enrolls in a new plan.
  • Override Initial – amount for the next levels up in the hierarchy from the Writing Agent for the initial payment.
  • Override True-up - amount for the next levels up in the hierarchy from the Writing Agent when CMS confirms a customer who has never had Medicare before enrolls in a new plan.
  • Street Renewal – Commissions paid to the Writing Agent starting in the next calendar year when the Policy remains in force.
  • Override Renewal – Commissions paid for the next levels up in the hierarchy from the Writing Agent starting in the next calendar year when the Policy remains in force.
  • Paid Thru Date – ending date that the transaction represents for the Payment. Typically for the Initial and True-up fields it would be the end of the year. For renewals that are typically paid monthly the Paid Thru Date would be the end of the month.
  • Payment Months – number of months represented by the payment. A full year it would be 12 months, and a Policy started in the middle of the year would be 6. Note: this field and the previous one Paid Thru date are not used in the commission calculation for MEDICARE The street/override first that are populated and the amount in them determines the amount paid. They are helpful for reporting and may be used for future enhancements.
  • Transaction Type – ‘Commission’ is always to be used. Other types may be used for future enhancements.
  • Source File/Batch ID - when transactions are imported, this is populated with the name of the file. Then if the transactions need to be removed, the file name listed here would be entered in the ‘Remove Transactions’ process.
  • Member Count – should be populated with a 1 when the Commission Received is a positive value, and -1 when the amount is negative.
  • Note – text can be entered.

Transaction History Page across all Policies

The Transaction History page will have two tabs when there is both MEDICARE and non-MAPD transactions. If there are only transactions for Policies with one of those two groups of Product Types, then only one tab will be seen.

Transaction history page showing menu path and option to Add New Transaction

When ‘Add New Transaction’ is selected from this list page, the add transaction detail page that opens will at first only have an entry field for Policy Number and display fields for Policyholder Name and Issuer. Once the Policy Number is entered, the system will derive the Product Type from the Policy and display the appropriate fields for the Type.

Add Transaction detail page prior to entering the Policy number:

Add transaction page after a MEDICARE Policy number is entered

Add Transaction if a non-MAPD Product Type Policy number is entered

Filter or Advanced Search from the Transaction List page

There is a filter or Advanced Search located in the transaction list page used across all policies. It can be opened by selecting the ‘Filters’ option or the ‘funnel icon’ located at the left. If either of those options is selected again it will close the filter.

Transaction History page with two options to open filter

The filter has different fields where values can be entered or selected. Then when Update Results is selected the results will be displayed in the list page or pages. If the results are only of one type, like only for Medicare Advantage and Medicare Prescription Product Types, then only the tab and list for that type will be displayed. If both MEDICARE and non-MAPD then the search results will display in the appropriate list page under the tab appropriate for the transaction type.

Filter in Transaction list page:

Transaction list page accessed from within a Policy

When transactions are accessed through the Policy List page or from within Policy details. The system will display fields in the list page and detail page to appropriate for the Policy Type. So, for MEDICARE Policies the fields for the Street and Override fields will be displayed.

Access to transactions from the Policy list page:

Access to transactions from Policy details

Note: when creating a Policy in the UI, you can directly go to the transaction link to create transactions as the system will save the Policy before going to the transaction list page.

Transaction History page accessed from within Policy details

Imports for Policies and Transactions

Policies and Transactions can be created manually or imported. There are four types of imports can be used for the Medicare Advantage and Medicare Prescription Product Types.

Policy Import – Used to edit existing Policies or to create new Policies. Can be used for all Product Types.

Transactions for MAPD & PDP – This import can be used when the admin wants to populate their own values into the Street and Override fields. If the Street and Override fields are left blank, the Medicare Engine will use the Commission Received Amount to determine the Street and Override field amounts. This import can also be used when the Commission Received amount is intended to not equal the amount populated/allocated to the Street/Override fields, but a warning will display. Typically, the amount of the Commission Received should equal a combination of the Street and Override fields but this allows for exceptions.

The ‘Transaction for MAPD & PDP’ import can create duplicate transactions if the same transaction (amount and paid thru date) is entered but will give a warning. If a mistake is made beyond what is desired to fix manually through the UI, it is best to use the ‘Remove Imports’ process for Transactions to remove the original transactions and then re-import a corrected file.

Policy & Transaction – This import will bring in both the Policy details and transactions. It can be used for both Medicare and non-MAPD Policies. When the Product type is MAPD or PDP, the Medicare Engine will then use the Commission Received amount to determine the allocation for the Street and Override amounts.

This import can also create duplicate transactions if the same transaction (amount and paid thru date) is entered but will give a warning. If a mistake is made beyond what is desired to fix manually through the UI, it is best to use the ‘Remove Imports’ process for Transactions to remove the original transactions and then re-import a corrected file. This will not remove the Policies that were created, just the transactions.

Transactions – This import can be used for both Medicare and non-MAPD Policies. When the Product type is MAPD or PDP, the Medicare Engine will then use the Commission Received amount to determine the allocation for the Street and Override amounts.

This import can also create duplicate transactions if the same transaction (amount and paid thru date) is entered but will give a warning. If a mistake is made beyond what is desired to fix manually through the UI, it is best to use the ‘Remove Imports’ process for Transactions to remove the original transactions and then re-import a corrected file.