Medicare Part D Eligibility Verification Transactions

An E1 transaction is a Medicare Eligibility Verification transaction that the pharmacy submits to the Part D transaction facilitator to determine a beneficiary's eligibility to the Part D program and other drug coverage information. 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 balance (Centers for Medicare & Medicaid Services, Medicare Prescription Drug Benefit Manual, Pub. No. 100-18, Ch. 14, § 30.4). We will review Centers for Medicare & Medicaid Services's oversight of E1 transactions processed by contractors and whether the E1 transactions were created and used for intended purposes. We will also review E1 transactions to assess the validity of the data.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
Completed	Centers for Medicare & Medicaid Services	Medicare Part D Eligibility Verification Transactions	Office of Audit Services	A-05-17-00020; W-00-17-35751	2020