Reconciliation

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Program Components:

Reconciliation

This page contains answers to Common Questions about Reconciliation. Review this page to learn about how to complete Reconciliation, when an application is ready for Reconciliation, and more. For additional information refer to the Reconciliation section of the RDS User Guide.

What is Reconciliation?

ANSWER: Within 15 months after the application Plan Year End Date, Plan Sponsors complete Reconciliation to finalize their application’s Covered Retiree List and submit final cost data to CMS' RDS Center. If the Plan Sponsor did not select an Interim Payment Frequency, it must use the Reconciliation process to request its annual payment.

Answer ID: 1000-1
Date Posted: 10/17/2014

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What is the Reconciliation Deadline?

ANSWER: The Reconciliation Deadline is the date by which a Plan Sponsor must complete Reconciliation. The Reconciliation Deadline is calculated as the last day of the fifteenth month after the Plan Year End Date (adjusted for Federal holidays and weekends). For Reconciliation Deadline dates, refer to Important Reconciliation Deadline Information. If interim payments were received and the Plan Sponsor does not complete Reconciliation by the Reconciliation Deadline, the sum of all payments received will become an overpayment, and CMS will initiate immediate action to recover those funds. Plan Sponsors that fail to meet the Reconciliation Deadline for a given application and have not received interim payments for that application will not be eligible for any subsidy payments for that application.

Answer ID: 1000-2
Date Posted: 10/17/2014 Last Updated: 01/08/2015

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Where can I find my Reconciliation Deadline?

ANSWER: The Reconciliation Deadline displays in the Details box on all Reconciliation pages including the Reconciliation Checklist page. The Reconciliation Deadline may also be viewed from the Application Status page, any page that displays the Application Information box, or the Benefit Option Final Cost List page.

Answer ID: 1000-3
Date Posted: 10/17/2014

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What is the Reconciliation Agreement?

ANSWER: The Reconciliation Agreement is an agreement with payment information that displays for and must be signed by the Authorized Representative when submitting a Reconciliation payment request. The Reconciliation Agreement must be completed in the RDS Secure Website. Refer to the Agreements page to review the text of the Reconciliation Agreement.

Answer ID: 1000-4
Date Posted: 10/17/2014

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What happens if I miss the Reconciliation Deadline?

ANSWER: For Plan Sponsors that fail to meet their Reconciliation Deadline for a given application and have received interim payments for that application, the sum of those payments becomes an overpayment, and CMS initiates immediate overpayment recovery action.

Plan Sponsors that fail to meet the Reconciliation Deadline for a given application and have not received interim payments for that application will not be eligible for any subsidy payments for that application. CMS' decision whether or not to afford additional time for Reconciliation or to deny a request for extension of the Reconciliation time limit is not subject to appeal.

Answer ID: 1000-5
Date Posted: 10/17/2014

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Who is responsible for completing Reconciliation?

ANSWER: Reconciliation steps are completed by a combination of individuals that include a Plan Sponsor's internal resources (such as the Account Manager, Authorized Representative, and Designee with Request Payment, Report Costs, or View/Send/Receive Retiree Data privilege) along with external resources such as Vendors who may be responsible for cost reporting, and a Plan Sponsor's banking institution.

The Reconciliation Overview is also beneficial for a Plan Sponsor's designated Vendors that may be performing key tasks in the Reconciliation process.

For more information about user roles in Reconciliation, refer to User Roles and Responsibilities in the Reconciliation Steps.

Answer ID: 1000-6
Date Posted: 10/17/2014

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What are the 12 steps of Reconciliation?

ANSWER: The 12 steps of Reconciliation are as follows:

  • Step 1: Initiate Reconciliation
  • Step 2: Review Payment Setup
  • Step 3: Request List of Covered Retirees
  • Step 4: Finalize Covered Retirees
  • Step 5: Start Preparation of Reconciliation Payment Request
  • Step 6: Manage Submission of Final Cost Reports
  • Step 7: Review Final Costs
  • Step 8: Enter Revisions to Final Costs
  • Step 9: Finalize Reconciliation Payment Request
  • Step 10: Review Electronic Funds Transfer (EFT) Information
  • Step 11: Approve Electronic Funds Transfer (EFT) Information
  • Step 12: Review and Submit Reconciliation Payment Request

Refer to the Reconciliation section of the RDS User Guide for overview information and step-by-step instructions to complete each step.

Answer ID: 1000-7
Date Posted: 10/17/2014

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When is my application ready for Reconciliation?

ANSWER: An RDS application is ready for Reconciliation when the following conditions are met.

  • The status of the application must be "Approved."
  • The application plan year has ended.
  • All desired interim payment requests have either been processed or canceled. (The maximum number of interim payment requests does not have to be used before initiating Reconciliation.)
  • Note: A Plan Sponsor cannot have a negative interim payment request when they start Reconciliation. If there is a negative interim payment, and it will not be fully offset by a positive payment request on another application, the Plan Sponsor needs to contact CMS' RDS Center to initiate the cancellation process.
  • At least 15 calendar days have passed from the date of the last interim payment determination.
  • Note: It is recommended that Plan Sponsors stop interim payments at least 60 days prior to an application's Reconciliation Deadline to focus on Reconciliation activities.
  • The Reconciliation Deadline has not passed.
  • Note: The Reconciliation Deadline displays in the Details box on all Reconciliation pages including the Reconciliation Checklist page. The Reconciliation Deadline may also be viewed from the Application Status page, all pages that display the Application Information box, and the Benefit Option Final Cost List page.

Note: After Step 1: Initiate Reconciliation is complete it cannot be reversed.

For more information, refer to the Reconciliation Toolkit.

Answer ID: 1000-8
Date Posted: 10/17/2014

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What is the Reconciliation Checklist?

ANSWER: The Reconciliation Checklist displays each of the 12 Reconciliation steps, the status of each step, the date the step was last updated or completed, and the RDS Secure Website user who last updated or completed the step.

For more information, refer to Reconciliation Checklist.

Answer ID: 1000-9
Date Posted: 10/17/2014

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What is the meaning of the icons next to items on the Reconciliation Checklist?

ANSWER: Icons appear before each step on the Reconciliation Checklist:

  • Green check mark - The step has been completed
  • Blue arrow - The next step to be completed or the step is in progress
  • Red exclamation point - The step needs attention
  • Yellow dash - The step is incomplete

Answer ID: 1000-10
Date Posted: 10/17/2014

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How do I complete Reconciliation?

ANSWER: The RDS Program Website offers a number of resources to assist Plan Sponsors with completing Reconciliation:

Answer ID: 1000-11
Date Posted: 10/17/2014

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