Molina Critical CMS Timelines for RFIs

Critical CMS Timelines for Requests for Information(RFIs)

This notice is to remind agents of critical timelines for Requests for Information (RFI), sometimes referred to as “pending applications” or “incomplete enrollment applications.”

For RFIs deemed as needing a valid election type, CMS requires resolution within seven (7) calendar days from the date the agent/plan received the enrollment application. Examples of these specific RFIs are:

• Election selected is not valid or available, such as (1) New to Medicare, however beneficiary is not new to Medicare entitlement; (2) Election selected was already used (LIS/OEP)
• No election was selected on the enrollment application

The plan must deny or submit the enrollment application within the same 7 (seven) calendar days.

For all other RFIs, CMS requires twenty-one (21) calendar days or the end of the month prior to effective date (whichever is later) to resolve the issue. Examples of these RFIs include:

• Proof of Medicaid eligibility
• Proof of Part A and/or Part B eligibility
• Proof of permanent residence

It is critical that agents adhere to these timeline requirements and be aware of these processes Molina has put in place:

• Molina’s Enrollment team sends letters and places phone calls to all impacted beneficiaries informing them of the reason for the RFI and the timeline required to resolve it
• Molina also has processes in place to notify sales agents of their RFIs, including timelines required to resolve them

If you have any questions:

• Brokers and Field Agents: Contact your Broker Channel Manager or Account Manager
• Telesales: Contact your immediate supervisor 

The Broker Services Unit can also be reached at (866) 440-9788. They are available Monday through Friday from 6 a.m. to 6 p.m. Mountain time.

‍