FIR transactions are designed to facilitate the real-time transfer of beneficiary information and TrOOP and Drugs Spend dollars accumulated between all Part D plans the beneficiary may have had during a calendar year.
FIR transactions are NCPDP transactions.
This transaction is sent to the very first plan for the beneficiary in a calendar year.
This transaction is sent to the last plan on record during the calendar year as of the date of the FIR transaction. This is also called the current plan of record for the beneficiary.
This transaction is sent to any additional plans between the first plan of record for the calendar year and the last or current plan of record for the calendar year. This transaction contains accumulators from any prior plans and allows for the plan(s) receiving the F3 to report their accumulators in addition to those reported by others in their response to this transaction.
Every time a beneficiary changes plans in a calendar year, there will be at minimum two FIR transaction types (F1 and F2) generated; however if the beneficiary has more than two plans in a calendar year, there will be three transaction types (F1, F2 and F3).
The entire process of sending FIR transactions to each of the beneficiary's plans is called a Sequence. Each FIR transaction is sent sequentially from the oldest (first plan in a calendar year) to the most current plan. Each Sequence will contain at minimum an F1 and an F2, but may also include an F3 if more than two plans exist for a beneficiary in a calendar year.
If the F3 is accepted, the plan receiving the F3 will respond to the F3. The response will either mirror back what prior plans have reported (if receiving plan does not have a any dollars to report for the month) or will contain the sum of prior plans and current plan accumulators (if prior plans had dollars to report and receiving plan has dollars to report in the same month). Additionally, the Part D plan should update their systems to reflect any dollars provided from prior plans.
Each additional plan except the plan that caused the FIR sequence to be initiated (the most current plan of record) will receive an F3.
If there are no additional plans other than the most current plan of record the Transaction Facilitator will send an F2 containing all prior plan dollars to the most current plan of record.
Many events can occur that result in a change to the way a claim originally processed. These events may occur even after the beneficiary has left (dis-enrolled) a plan. For example, a plan may receive a retroactive change to the Low-Income Cost Sharing that requires claims to be adjusted. Other examples may be the receipt of latent supplemental payer information (N transactions), paper claims submitted by the beneficiary, reversal or non-coverage of claims previously paid, and end-of-year reconciliation. All of these can impact the beneficiary's accumulators. To account for these changes, the Transaction Facilitator automatically submits FIR sequences multiple times, as defined in the schedule below, to all plans to communicate any changes to the beneficiary's accumulators.
FIR sequences are sent based on the following schedule, which is called a Series unless a new event (e.g. beneficiary moves to another plan) restarts the Series at which time the schedule restarts based on that new event. The specific timing of each sequence in a series is listed below:
If a Part D Plan continues to experience changes to the beneficiary's prior plan year accumulators between March 31st and May 31st, the plan can request the Transaction Facilitator to initiate a FIR sequence.
For additional information on FIR timing and examples, please consult FIR Timing Examples which can also be found under the Related Documents section of this page.
For accumulator balance changes that occur after May 31st following a plan year, CMS and the industry worked together to define a set timeframe (which is roughly quarterly) to retrigger prior plan year FIRs. This process is called the Mass Retrigger process and only beneficiaries that had FIR transactions in a prior plan year will be retrigger during the mass event. Plans may not request a manual retrigger once FIRS have reached the Mass Retrigger stage. See a schedule of Mass Retrigger dates, which can also be found under the Related Documents section of this page.