Disenrollment from Health Plans
This section of the manual provides information on:
Disenrollment occurs when health plan enrollment ends for an enrollee. Disenrollment can occur both systematically and by a manual update.
Review the Edit Health Plan Enrollment page in OneSource for instructions on how to update MMIS for disenrollment.
The effective date for a disenrollment follows managed care capitation dates.
Disenrollment Reasons
DIS RSN Code: AP
Reason: Appeals
Who can enter this code: DHS
Description and when to use this code: Used when an appeal decision was made that ended health plan enrollment.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: An appeal decision was made, that closed your health plan enrollment.
DIS RSN Code: BP
Reason: No reenrollment
Who can enter this code: System entered
Description and when to use this code: Used to prevent reenrollment into a health plan that is not accepting reenrollments.
Does this code allow automatic reenrollment: No
Does this code allow automatic reinstatement: Yes. Reinstatement occurs before coverage ends on the last day of the same month.
Disenrollment Notice Text: Your health plan is no longer available in the county where you live and you must choose a different health plan.
DIS RSN Code: CP
Reason: Capitation error
Who can enter this code: System entered
Description and when to use this code: Generated by the system when there is a processing error related to capitation.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: You no longer meet the enrollment criteria to remain enrolled in your health plan for one of these reasons:
DIS RSN Code: DT
Reason: Death
Who can enter this code: System entered
Description and when to use this code: Used when an enrollee dies and eligibility is closed and the date of death interfaces from METS or MAXIS to MMIS.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your health plan has ended due to a report of death.
DIS RSN Code: EE
Reason: Eligibility ended
Who can enter this code: Counties, Tribes, DHS or system entered
Description and when to use this code: Used when an enrollee is no longer eligible for Minnesota Health Care Programs (MHCP). They will be disenrolled from their health plan on the last day to match the end date of MHCP eligibility.
Or
When an enrollee’s eligibility type changes, their health plan enrollment may end, change or stay the same depending on the change.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: Your MA or MinnesotaCare eligibility has ended or changed.
DIS RSN Code: EX
Reason: Exclusion
Who can enter this code: Counties, Tribes or DHS
Description and when to use this code: Used when an enrollee meets an exclusion reason. They will be disenrolled from their health plan.
The type of exclusion will determine if they will be disenrolled for the next available month or if they will be disenrolled for past months and capitation recovered.
Refer to Disenrolling Excluded Enrollees section of this page for more information.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You are no longer required to be enrolled in a health plan. If you would like to voluntarily enroll, contact your worker to see if you are eligible.
DIS RSN Code: FY
Reason: First year change option
Who can enter this code: Counties, Tribes, DHS or system entered
Description and when to use this code: Used when an enrollee uses a first-year change option.
Refer to Changing Health Plans in this manual for more information on change options.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: You have requested to change plans. You will receive another letter telling you when to start getting services through your new health plan.
DIS RSN Code: HP
Reason: Health plan contract ended
Who can enter this code: Counties, Tribes or DHS
Description and when to use this code: Used when a health plan is no longer available in the county of residence.
Refer to Changing Health Plans in this manual for more information on change options.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your health plan is no longer available in the county where you live. You will receive another letter telling you when to start getting services through your new health plan.
DIS RSN Code: JL
Reason: Jail incarceration
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee is incarcerated. They will be disenrolled from their health plan even if they remain eligible for MHCP. DHS Managed Care staff will add a JJ exclusion on RPPH for the months the enrollee is incarcerated. Refer to Exclusions in this manual for more information.
Refer to the Incarceration Landing Page in OneSource for more information on adding, changing, or ending incarceration spans.
Upon release from incarceration, they may be reenrolled or reinstated in their previous health plan.
Refer to Reenrollment and Reinstatement in this manual for more information.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your health plan has ended due to a report you are incarcerated.
DIS RSN Code: MV
Reason: Move
Who can enter this code: Counties, Tribes, DHS or system entered
Description and when to use this code: Used when an enrollee moves to a county that does not offer their current health plan. Their health plan will end for the next available month.
They must select a new plan available in their new county of residence or be defaulted into one.
Refer to Changing Health Plans in this manual for more information on change options.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: Your health plan has ended because you moved out of the health plan service area. You must choose a new health plan.
DIS RSN Code: ND
Reason: Loss of disability
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee is no longer certified disabled.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You no longer meet the enrollment criteria to remain enrolled in your health plan because your disability certification has ended. Contact your worker for more information.
DIS RSN Code: NT
Reason: Ninety day change option; 90 days of less from health plan change
Who can enter this code: Counties, tribes, DHS or system entered
Description and when to use this code: Used when an enrollee chooses a new health plan within the first 90 days of health plan enrollment.
Refer to Changing Health Plans in this manual for more information on change options.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: You have requested to change health plans. You will receive another letter telling you when to start getting services through your new health plan.
DIS RSN Code: OE
Reason: Open Enrollment
Who can enter this code: Counties, Tribes or DHS
Description and when to use this code: Used when an enrollee returns an Annual Health Plan Selection (AHPS) notice and selects a new health plan.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: You have requested to change health plans. You will receive another letter telling you when to start getting services through your new health plan.
DIS RSN Code: OT
Reason: Other
Who can enter this code: DHS or system entered
Description and when to use this code: Used by DHS when an enrollee’s health plan enrollment needs to be ended to facilitate case maintenance, non-standard change options, or other reasons that are not covered by a DIS RSN code listed in this chart.
Refer to case notes for details on a specific case.
Does this code allow automatic reenrollment or reinstatement: Yes
Disenrollment Notice Text: You no longer meet the enrollment criteria to remain enrolled in your health plan for one of these reasons:
DIS RSN Code: PA
Reason: Loss of Part A; Medicare Part A ended
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee’s Medicare Part A eligibility or enrollment has ended.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your Medicare Part A eligibility has been changed or ended. Contact your worker for more information.
DIS RSN Code: PB
Reason: Loss of Part B; Medicare Part B ended
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee’s Medicare Part B eligibility or enrollment has ended.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your Medicare Part B eligibility has been changed or ended. Contact your worker for more information.
DIS RSN Code: PD
Reason: Loss of Part D; Medicare Part D ended
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee’s Medicare Part D eligibility or enrollment has ended.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your Medicare Part D eligibility has been changed or ended. Contact your worker for more information.
DIS RSN Code: PM
Reason: PMI merge
Who can enter this code: DHS
Description and when to use this code: Used when multiple Person Master Indexes (PMI) for the same member are merged.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You had more than one PMI (ID number). Contact your worker for more information.
DIS RSN Code: RC
Reason: Retro change; CMS changed Medicare enrollment retroactively
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee’s Medicare eligibility or enrollment has been added, changed or ended. They may meet an exclusion reason and be disenrolled from their health plan. DHS receives transaction data from the Centers for Medicare and Medicare Services (CMS).
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You have requested to change plans. You will receive another letter telling you when to start getting services through your new plan.
DIS RSN Code: SE
Reason: Service ending
Who can enter this code: DHS or system entered
Description and when to use this code: Used when a health plan is no longer available in the county of residence.
Refer to Changing Health Plans in this manual for more information.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: Your health plan is no longer available in the county where you live. You will receive another letter telling you when to start getting services through your new health plan.
DIS RSN Code: SP
Reason: Nonpayment of spenddown
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee has not paid their spenddown in full for 3 months.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You have not paid your medical spenddown to the state. Contact the DHS accounting department at 1-800-657-3762 to pay your outstanding balance.
DIS RSN Code: TA
Reason: Temporary absence
Who can enter this code: Counties, Tribes or DHS
Description and when to use this code: Used when a PMAP enrollee is absent from Minnesota for more than 30 consecutive days but is still considered a resident of Minnesota.
Refer to Temporary Absence MMIS Exclusion and Disenrollment instructions in OneSource for more information.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: MA Coverage While Temporarily Away from MN - Manual Notice (PDF): You reported that the person(s) listed here is temporarily away from Minnesota. This means they will get MA coverage through "fee for service."
DIS RSN Code: TC
Reason: Tran change/Select different plan; changed health plans for Medicare
Who can enter this code: DHS
Description and when to use this code: Used when an enrollee selects a Medicare Prescription Drug Plan.
The enrollee will be disenrolled from Integrated SNBC or MSHO.
Refer to the Disenrollment from MSHO and SNBC section of this manual for more information.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You have selected a different Medicare prescription drug plan. This automatically disenrolls you from either MSHO or NBC. You will receive another letter telling you about how to continue to get covered services.
DIS RSN Code: VL
Reason: Voluntary
Who can enter this code: DHS
Description and when to use this code: Used when an SNBC, MSHO or MSC+ enrollee changes their health plan.
Refer to Changing Health Plans in this manual for more information.
Does this code allow automatic reenrollment or reinstatement: No
Disenrollment Notice Text: You have voluntarily disenrolled or changed health plans. If you changed plans, you would receive another letter telling you when to start getting services through your new health plan.
Disenrolling Excluded Enrollees
Certain enrollees are disenrolled from their health plan when they meet criteria that allows or requires an exclusion. They remain eligible for MHCP as fee for service (FFS) and their providers submit claims directly to DHS for payment.
For detailed information on exclusions including a list of Exclusion Reasons (XCL) refer to the Exclusions page of this manual.
When an enrollee meets the criteria for an exclusion, the processing entity will update RPPH in MMIS to end their health plan enrollment. For instructions on how to update MMIS for an enrollee who qualifies for an exclusion, refer to Adding and Ending Exclusions in OneSource.
Disenrollment Notices
MMIS issues a notice with the disenrollment reason and the end date of enrollment when an enrollee is disenrolled from their health plan.
Reenrollment and Reinstatement
When an enrollee is disenrolled from their health plan because their eligibility ended or an exclusion was added, MMIS or a processing entity may reenroll or reinstate the enrollee into their previous health plan if their eligibility is restored or the exclusion is ended.
Find more information on Reenrollment and Reinstatement in the following locations:
Reenrollment and Reinstatement in MHCP Managed Care Manual
Managed Care Enrollment Process in OneSource
Managed Care Reopen-Reinstate in MMIS User Manual
Disenrollment from MSHO and SNBC
MSHO enrollees, Non-Integrated SNBC and Integrated SNBC enrollees have multiple options they can use to disenroll from a health plan. Enrollees can select the option that best fits their needs.
Disenrollment Process from MSHO
Enrollees 65 or over (Seniors) must be enrolled in a health plan unless they meet an exclusion reason. By default, they will be enrolled in MSC+. Seniors with Medicare A and B have the option to enroll in MSHO instead of MSC+. When an enrollee disenrolls from MSHO, and they do not meet exclusion criteria, they will be enrolled in MSC+.
MSC+ enrollees with Medicare will get coverage from:
When disenrolling from MSHO, all enrollees will need to select a Part D plan in addition to their MSC+ plan so they can continue getting prescription drug coverage. They can contact the Senior Linkage Line at 800-333-2433 (this call is free) or 800 MEDICARE (800-633-4227) (this call is free) to do this.
Option 1: Disenroll from MSHO by selecting a Part D plan.
Option 2: Disenroll from MSHO by fax.
Option 3: Change MSHO plans.
Managed Care – Department of Human Services
PO Box 64984
St. Paul, MN 55164-0838
Option 4: Contact their current MSHO health plan.
Disenrollment Process from Integrated SNBC
There are several options an enrollee can disenroll from Integrated SNBC. An enrollee can move from Integrated SNBC to Non-Integrated SNBC or FFS at certain times of the year but not monthly. Refer to the Changing Health Plans page of this manual for more information.
When disenrolling from Integrated SNBC, all enrollees will need to select a Part D plan so they can continue getting prescription drug coverage. They can contact the Senior Linkage Line at 800-333-2433 (this call is free) or 800 MEDICARE (800-633-4227) (this call is free) to do this.
Changing from Integrated SNBC to FFS:
Option 1: Disenroll from Integrated SNBC by selecting a Part D plan.
Option 2: Contact their current Integrated SNBC health plan.
Option 3: By mail or fax.
Managed Care – Department of Human Services
PO Box 64984
St. Paul, MN 55164
Changing from Integrated SNBC to Non-Integrated SNBC:
Enrollees who disenroll from an Integrated SNBC plan will be moved to FFS unless they indicate otherwise. If an enrollee wants to disenroll from Integrated SNBC and move to Non-Integrated SNBC, the enrollee can:
Or
To ensure their medications are covered, the enrollee needs to contact the Senior LinkAge Line at 800-333-2433 (this call is free) to pick a new Part D prescription drug plan. If they do not select a Part D plan, Medicare will assign one, but their prescription drugs may not be covered by that plan.
Disenrollment Process from Non-Integrated SNBC
Enrollees in a Non-Integrated SNBC health plan can disenroll each month and get their medical coverage as FFS by:
Managed Care – Department of Human Services
PO Box 64838
St. Paul, MN 55164-0838
Partners and providers can submit this form through the Health Care Consumer Support Document Portal on behalf of an enrollee
For Non-Integrated SNBC enrollees’ enrollment to end on the last day of the current month, their disenrollment request must be received and processed by DHS at least 6 days before the end of the current month.
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