Complete Payment Setup

User Roles:

AM

AR

Program Components:

Payment Setup

This section provides an overview and step-by-step instructions for completing Payment Setup.

Overview

This section provides an overview of the following topics related to completing Payment Setup:

Payment Setup Process Steps

The Payment Setup Process consists of six steps:

  1. Assign Payment Requester Privilege to Authorized Representative
  2. Assign Payment/Cost Privilege to Account Manager
  3. Assign Payment/Cost Privilege to Designee(s)
  4. Specify Vendors for Cost Reporting
  5. Assign Benefit Options to Cost Reporters
  6. Final Review to Complete Payment Setup

All six steps of Payment Setup must be complete to finalize Payment Setup. Plan Sponsors cannot submit cost reports or payment requests until Payment Setup is complete.

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Payment Setup Guidelines

Plan Sponsors should understand the following guidelines before initiating Payment Setup:

  • The same person cannot be both a Payment Requester and a Cost Reporter. A single individual may not have both the Report Costs privilege and the Request Payment privilege on a given application. A Cost Reporter cannot request payments, and a Payment Requester cannot report costs. This separation of duties guards the RDS Program against fraud and protects taxpayer dollars. The RDS Secure Website enforces this separation of duties requirement during the Payment Setup process.
  • Possible Payment Requesters include: Authorized Representatives (who are automatically assigned this privilege by the system); Account Managers manually assigned the Request Payment privilege; and Designees assigned the Request Payment privilege.
  • Possible Cost Reporters include: Account Managers manually assigned the Report Costs privilege; Designees assigned the Report Costs privilege; and Vendors. Vendors can report cost data, but they can never request payments.
  • Cost Reporter Designees attached to Vendors are considered Vendor Designees.
  • Cost Reporter Designees not attached to Vendors are considered Plan Sponsor Designees.
  • Cost Reporters must be assigned a Reporting Method. There are two reporting methods for submitting costs: Data Entry and Mainframe.
  • Plan Sponsor Cost Reporters must be assigned the same Reporting Method. The Plan Sponsor Cost Reporters must either submit cost data by Data Entry or by Mainframe. The Plan Sponsor cannot use both methods on the same application.
  • At least one Cost Reporter must be assigned to each Benefit Option.
  • Plan Sponsor and Vendor Cost Reporters are separate sources. The source becomes particularly important if multiple Cost Reporters report on the same Benefit Option for the same plan month. Cost data reported by the same source overwrites (replaces previously submitted data), while cost data reported by different sources are added together.
  • All six Payment Setup steps must be completed to finalize Payment Setup.
  • Payment Setup must be completed to report costs or request payment.

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Cost Report Submission Methods

There are two methods to submit cost reports to CMS' RDS Center: (1) Manual Data Entry using the RDS Secure Website and (2) Mainframe. All steps of Payment Setup must be complete to submit cost reports. If Payment Setup is not complete, Data Entry Cost Reporters cannot enter costs, and Mainframe cost reports will be rejected by CMS' RDS Center.

Manual Data Entry Using the RDS Secure Website

The Manual Data Entry process requires a user to access the RDS Secure Website and manually enter aggregated retiree cost data by Benefit Option and plan month.

RDS Center Mainframe Submission

The Mainframe process requires a Vendor or a Plan Sponsor to submit aggregated retiree cost data by Benefit Option and plan month using a Mainframe to Mainframe connection. Cost data sent using a Mainframe connection is viewable in the RDS Secure Website if basic format edits are passed; however, cost data reported using a Mainframe connection cannot be changed using the RDS Secure Website. To revise cost data submitted using the Mainframe, revised cost data files must be submitted using a Mainframe connection, and then the new data displays on the RDS Secure Website.

If a Vendor reports costs using the Mainframe, the Plan Sponsor may assign one of the Vendor's employees as a Designee with the Report Costs privilege (for example, an RDS Secure Website user), so that they may view the cost report data that the Vendor submitted on the RDS Secure Website. The Designee must establish an RDS Secure Website user account by completing Registration to view the cost data submitted by the Vendor.

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User Roles and Responsibilities for Completing Payment Setup

RDS User Roles and Responsibilities

Authorized Representative and Account Manager

The Authorized Representative and Account Manager are the only RDS Secure Website user roles that have the authority to access Payment Setup. The Authorized Representative or Account Manager is required to complete each of the six Payment Setup steps and submit the completed Payment Setup to CMS' RDS Center for processing.

To protect the RDS Program against fraud and protect taxpayer dollars, the RDS Secure Website enforces a separation of duties requirement during the Payment Setup process. As a result, the Authorized Representative is always a Payment Requester on an application and can never report costs. The Authorized Representative is the only individual who may submit the annual Payment Request or Reconciliation Payment Request; they will automatically be assigned the Request Payment privilege. As a result, the Authorized Representative cannot be a Cost Reporter. The Authorized Representative has the ability to view interim and final cost reports for all Benefit Options. The Authorized Representative does not have the ability to report costs for any Benefit Option.

The Account Manager must decide if they want to report costs or request payment, but they cannot perform both payment-related privileges on the same application. The separation of duties requirement is at an application level so it is possible for an Account Manager to report costs on one application, and request interim payment on another, if necessary.

Since the same individual cannot report costs and request payment on the same application, the Plan Sponsor must identify the payment-related privilege for the Account Manager during the Payment Setup process. The Account Manager can either select: request payment and, consequently, only view cost data; report costs and, consequently, only view payment data; or only view both cost and payment data.

Designees

A Designee can be assigned either the Report Costs privilege or the Request Payment privilege, but not both on the same application. The Plan Sponsor must decide to assign Report Costs privileges or Request Payment privileges to existing Designees already assigned to the application, or assign new Designees during the Payment Setup process.

Designees assigned the Report Costs privilege have the ability to view cost data for their assigned Benefit Options. Designees may enter costs for the associated Benefit Options if assigned the Data Entry reporting method or assigned to a Vendor with the Data Entry reporting method.

For interim payments, Designees assigned the Request Payment privilege are permitted to submit interim payment requests, review interim costs when preparing the payment request, and view all cost reports for that application. At Reconciliation, Designees assigned the Request Payment privilege may serve as a Payment Verifier by reviewing final costs and viewing final cost reports. For more information on which Reconciliation steps Designees may access, refer to User Roles and Responsibilities in the Reconciliation Steps.

Plan Sponsors that want Vendors to report cost data using the Data Entry reporting method need to assign an employee of the Vendor as a Designee. The Plan Sponsor is not required to assign Designees as Cost Reporters or Payment Requesters — this is only necessary if someone other than the Authorized Representative and the Account Manager is handling either one of these payment privileges.

A Plan Sponsor must have at least one Cost Reporter assigned to each Benefit Option. If a Vendor reporting by the Data Entry reporting method is assigned as a Cost Reporter, a Designee must be assigned to the Vendor. If the Account Manager is not reporting costs, then a Designee and/or Vendor must be assigned as a Cost Reporter.

System-Specific Roles and Responsibilities

Cost Reporter

A Cost Reporter is an individual or a Vendor that is responsible for submitting drug cost data to CMS' RDS Center. During the Payment Setup process, Plan Sponsors identify Cost Reporters for each Benefit Option defined within an application. Plan Sponsors may choose to assign any of the following as Cost Reporters: the Account Manager, any existing Designee already assigned to the application, any new Designee added to the application, or a Vendor. Cost Reporters are assigned to an application, and Benefit Options are then assigned to Cost Reporters. A Cost Reporter must be assigned to each Benefit Option for the Payment Setup process to be complete.

There are two source types that can submit cost data: the Plan Sponsor and Vendor(s). A Plan Sponsor is considered a single source regardless of the number of individual Cost Reporters assigned to the Plan Sponsor's application. Each Vendor is considered a single source regardless of the number of individual Cost Reporters assigned to the Vendor.

Note: Plan Sponsor Cost Reporters and Vendor Cost Reporters are separate sources. Source becomes particularly important if multiple Cost Reporters report costs on the same Benefit Option for the same plan month. Cost data reported by the same source replaces previously submitted data, while cost data reported by different sources are added together.

Payment Requester

A Payment Requester is an individual granted permission to create and submit interim payment requests and prepare the final Reconciliation payment request using the RDS Secure Website. Only the Authorized Representative can submit the final Reconciliation payment request. The Authorized Representative always has the Request Payment privilege for all the applications they are assigned. The Account Manager and Designees may also be assigned the Request Payment privilege for submitting interim payment requests and for helping to prepare the Reconciliation payment request. For more information on which Reconciliation steps are accessible for users assigned the Request Payment privilege, refer to User Roles and Responsibilities in the Reconciliation Steps. The Request Payment privilege is assigned at the application level.

Vendor

A Vendor is a Pharmacy Benefit Manager (PBM), Health Plan, or other third party company that has been contracted by a Plan Sponsor to report costs. During the Payment Setup process, a Plan Sponsor specifies if any Vendors are reporting costs for the application based on the Vendor ID. Using a Vendor to report cost data is optional.

A Vendor may report costs using the RDS Secure Website or a Mainframe connection.

A Vendor is required to request a Vendor ID from CMS' RDS Center, and each Vendor ID has a cost report submission method (either Data Entry or Mainframe) as specified by the Vendor.

For example, if Vendor ABC is reporting costs for Application ID 12345 using the Mainframe reporting method, Vendor ABC needs to request a Vendor ID from CMS' RDS Center for the Mainframe reporting method. If Vendor ABC is also reporting costs for Application ID 67890 using the Data Entry reporting method, they need to request an additional Vendor ID associated with the Data Entry reporting method.

A Vendor that wants to initiate the Registration process and request a Vendor ID for the RDS Secure Website needs to contact CMS' RDS Center. After the Vendor receives the Vendor ID, they must communicate the Vendor ID to the appropriate Plan Sponsors so it can be entered in Payment Setup on the RDS Secure Website as applicable.

Plan Sponsor Designee Cost Reporter/Vendor Designee Cost Reporter Differences

A Plan Sponsor Designee Cost Reporter is a Designee assigned the Report Costs privilege that is not assigned to a Vendor. A Vendor Designee Cost Reporter is a Designee that is assigned to a specific Vendor. By associating a Designee with a Vendor, the Designee is given permission to view or report cost data on behalf of the Vendor. A Plan Sponsor Designee does not have access to any Vendor costs reports. A Vendor Designee does not have access to any cost reports reported by the Account Manager, Plan Sponsor Designee, or another Vendor.

At least one Cost Reporter must be assigned to each Benefit Option; however, a single Benefit Option may have more than one Cost Reporter. The Cost Reporters can be multiple Vendors, multiple Plan Sponsor Cost Reporters, or a combination of the two.

Each Plan Sponsor Cost Reporter must be assigned a reporting method. If multiple Plan Sponsor Cost Reporters are reporting costs for the same application, they must all use the same reporting method. They must all use the Data Entry or Mainframe reporting method—not a combination of the two. This rule only applies to cost data reported by multiple Plan Sponsor Cost Reporters and not by Vendors. Vendor Designees inherit the reporting method from their Vendor. A reporting method is not assigned directly to a Vendor Designee.

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Common Mistakes to Avoid in Payment Setup

Common mistakes to avoid in Payment Setup include:

  • Not assigning a Benefit Option to a Vendor. When a Benefit Option is not assigned to a Vendor, the costs submitted by the Vendor are rejected, and the Designee for the Vendor is prohibited from entering cost data for the Benefit Option.
  • Not attaching a Designee to a Vendor. When a Designee is not attached to a Vendor, the Designee is considered a Plan Sponsor Designee. Plan Sponsor Designees do not have access to Vendor cost reports. If a Vendor is submitting cost reports through Data Entry, Payment Setup cannot be completed until a Cost Reporter Designee is assigned to a Vendor.
  • Setting up both the Plan Sponsor and Vendor to report cost data on the same Benefit Option. When both the Plan Sponsor and Vendor report cost data on the same Benefit Option for the same plan month, the cost data figures are added together and can result in a potential duplication.
  • Not completing Payment Setup. When Payment Setup is "Incomplete," cost data cannot be reported, Vendor files are rejected, and Data Entry is prohibited on the RDS Secure Website.
  • Not setting up a Vendor for Data Entry. If the Designee reports costs without being attached to the Vendor, the cost report activity will not be included in the Vendor's Quick Access Reports (QAR).

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Changing Payment Setup

Note: Payment Setup is accessible from the Application List page until Reconciliation is initiated and after Reconciliation is complete. During Reconciliation, Payment Setup is only accessible from the Reconciliation Checklist.

CMS' RDS Center does not limit the number of times changes can be made to Payment Setup. However, Payment Setup must be completed before a cost report is submitted or a Payment Request is made.

Before cost data is reported, anything can be changed in Payment Setup. It is not until after cost data has been reported that there are rules on what can be changed in Payment Setup.

After a Cost Reporter has reported costs, the following Payment Setup actions are disabled:

  • Change Account Manager from Report Costs privilege to View Only or to Request Payment privilege
  • Change Plan Sponsor Designee from Report Costs privilege to Request Payment privilege
  • Remove a Vendor
  • Remove Benefit Options assigned for which the Cost Reporters (Vendor or Plan Sponsor) have reported costs

Refer to Change Payment Setup for information about and step-by-step instructions for changing Payment Setup.

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Step-by-Step Instructions

This section contains step-by-step instructions to complete the Payment Setup process:

Access the Payment Setup Menu

To access the RDS Secure Website and navigate to the Application List page, review instructions to access the RDS Secure Website.

From the Application List page:

  1. Find the appropriate Application ID.
  2. Select Payment Setup from the Actions dropdown menu and then select Go, or select Payment Setup in the Payment Setup Status column.

    Note: Access to Payment Setup from the Application List page is available when the Application Status is "Approved" or "Reconciliation Request Complete."

     Select [Payment Setup link]; Select [Payment Setup] from Actions.

On the Payment Setup page:

  1. To view details of the selected Payment Setup, select View Payment Setup Options.
  2. To complete Payment Setup, select each of the Payment Setup Steps in the Payment Setup Menu.

    Payment Setup menu

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Complete Step 1: Assign Payment Requester Privilege to Authorized Representative

Step 1 is automatically completed. This occurs because the Authorized Representative's payment-related privilege always defaults to the Request Payment privilege and cannot be changed. The Authorized Representative is not required to request interim payments but is obligated to request the final Reconciliation payment. As outlined in the following steps, the Account Manager or a Designee can also be assigned the Request Payment privilege for an application.

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Complete Step 2: Assign Payment/Cost Privilege to Account Manager

Purpose of Step 2: Assign Payment/Cost Privilege to Account Manager

In Step 2, the Plan Sponsor is required to assign the Account Manager one of the following privileges: Request Payment, Report Costs, or View Only. The Plan Sponsor must select one of these options.

An Account Manager can either: Request Payment and, consequently, only view cost data; Report Costs and, consequently, only view payment data; or only view both cost and payment data.

  • Request Payment: The Request Payment privilege allows the Account Manager to request interim payments for the given application.
  • Report Costs: The Report Costs privilege allows the Account Manager to report costs for the given application.
  • View Only: The View Only privilege allows the Account Manager to view costs and payment requests.

Assign Payment/Cost Privilege to Account Manager

To access Step 2: Assign Payment/Cost Privilege to Account Manager, refer to Access the Payment Setup Menu.

On the Assign Payment/Cost Privilege to Account Manager page:

An asterisk (*) indicates a required field.

  1. *Select the appropriate radio button: Request Payment, Report Costs, or View Only.
  2. Select Continue to proceed or select Cancel to return to the Payment Setup Menu page without saving your selection.

    Assign Payment/Cost Privilege to Account Manager: Select [Continue]

On the Assign Payment/Cost Privilege to Account Manager Confirmation page:

  1. Select Confirm to proceed or select Cancel to return to the Payment Setup Menu page without saving the selection.

    Assign Payment/Cost Privilege to Account Manager Confirmation: Select [Confirm]

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Complete Step 3: Assign Payment/Cost Privilege to Designee(s)

Purpose of Step 3: Assign Payment/Cost Privilege to Designee(s)

In Step 3, the Plan Sponsor may choose to assign Plan Sponsor Designees the Request Payment or Report Costs privilege. If the Plan Sponsor is using Designees, the Designees must be identified in this step if they were not already identified in the Application Submission Process. A Designee is an optional registered RDS participant used to complete tasks in the RDS Program Lifecycle to assist the Plan Sponsor.

A Designee can be assigned either the Report Costs or the Request Payment privilege, but not both on the same application. A Plan Sponsor must decide to assign payment-related privileges to existing Designees that are already defined in the application, or add new Designees during the Payment Setup process and assign them payment-related privileges.

Note: A Designee must be assigned the Report Costs privilege in this step to report costs to CMS' RDS Center. A Designee must be assigned the Request Payment privilege in this step to request an interim payment.

Assign Payment/Cost Privilege to Designee(s)

To access Step 3: Assign Payment/Cost Privilege to Designee(s), refer to Access the Payment Setup Menu.

On the Assign Payment/Cost Privilege to Designee(s) page:

An asterisk (*) indicates a required field.

  1. *Select Yes to assign Payment Request or Cost Reporting Privileges, or maintain Designee privileges, or select No to return to Payment Setup Menu page.
  2. Select Continue to proceed or select Cancel to return to the Payment Setup Menu page.

    Note: The Assign Payment/Cost Privilege to Designee(s) page allows the Plan Sponsor's Account Manager or Authorized Representative to indicate whether to assign Report Costs or Request Payment privileges to one or more Designees. This page displays only if this question has never been answered for the appropriate application when "Assign Payment/Cost Privileges to Designee(s)" is selected on the Payment Setup Menu page. After entering a response on this page, the page no longer displays; instead, a list of Designees already assigned to the application displays.

    Assign Payment/Cost Privileges to Designee(s): Select [Continue]

On the Assign Designee Payment/Cost Privilege Summary page:

  1. Select Assign a Designee to assign a new Designee or select Continue to return to the Payment Setup Menu page. Assign Designee Payment/Cost Privilege Summary: Select [Assign a Designee] link.

On the Assign Designee page:

An asterisk (*) indicates a required field.

  1. *Enter the Designee's Email Address.
  2. Select Continue to search for the Email Address or select Cancel to return to either the Application Status page or the Payment Setup Menu page.

     Enter [E-mail Address]; Select [Continue]

Selecting Continue navigates to one of three pages:

  • Option 1: Designee Cannot Use page: The Email Address entered has been found, but this person cannot be assigned as a Designee because they are already associated with a user account that has a different role.
  • Option 2: Designee Not Found page: The Email Address entered was not found, and this person can be assigned as the Designee.
  • Option 3: Designee Found page: The Email Address entered has been found, and this person can be assigned as the Designee.

Option 1: On the Designee Cannot Use page:

  1. Select Continue to return to the Assign Designee page to search again.

     Select [Continue]

Or
Option 2: Designee Not Found page:

  1. Select Continue to assign a new Designee or select Cancel to return to the Assign Designee page.

     Select [Continue]

On the Assign New Designee page:

An asterisk (*) indicates a required field.

  1. *Enter the First Name.
  2. Enter the Middle Initial.
  3. *Enter the Last Name.
  4. *Enter the Pass Phrase.
  5. *Re-enter Pass Phrase.
  6. Select Continue to proceed to the Assign Designee Privileges page or select Cancel to return to the Assign Designee page.

     Select [Continue]

Or
Option 3: Designee Found page:

  1. Select Continue to assign the Designee and proceed to the Assign Designee Privileges page or select Cancel to return to the Assign Designee page.

    Screen shot of Designee Found with emphasis on Continue.

On the Assign Designee Privileges page:

  1. In the Costs and Payment section, select the checkbox for the Report Costs privilege or the Request Payment privilege.

    Note: A user may not report costs and request payments on the same application.

  2. Select Continue to proceed or select Cancel to return to the Assign Designee page.

     Select [Cost and Payment] Privilege; Select [Continue]

On the E-PHI Agreement page:

  1. Read the E-PHI Agreement. Select Accept to authorize the Designee to access or use E-PHI associated with the Plan Sponsor's RDS application. Select Decline to return to the Assign Designee Privileges page.

     Select Accept

On the Assign Designee Verification page:

  1. Select Confirm to assign the Designee or select Cancel to return to the Assign Designee Privileges page.

     Select [Confirm]

On the Assign Designee Confirmation page:

  1. Select Continue to return to the Assign Designee Payment/Cost Privilege Summary page.

     Select [Continue]

Change Designee Privileges

A Designee can be assigned the Report Costs privilege or the Request Payment privilege, but not both on the same application. A Plan Sponsor can decide to assign these payment-related privileges to existing Designees already defined on the application, or add new Designees during the Payment Setup process and assign them a payment-related privilege.

To access Step 3: Assign Payment/Cost Privilege to Designee(s), refer to Access the Payment Setup Menu.

On the Assign Designee Payment/Cost Privilege Summary page:

  1. Select the Designee Name link to access Designee information and change a Designee's privileges.

    Assign Designee Payment/Cost Privilege Summary: Select [Designee Name]

On the Maintain Designee page:

  1. Select Change Privileges to change a Designee's privileges or select Cancel to return to the Assign Designee Payment/Cost Privilege Summary page.

     Select [Change Privileges]

On the Change Designee Privileges page:

  1. In the Costs and Payment section, select the checkbox for the Report Costs privilege or the Request Payment privilege.

    Note: A user may not report costs and request payments on the same application. Additionally, the Report Costs privilege cannot be removed if the Designee has already reported costs.

  1. Select Continue to proceed or select Cancel to return to the Maintain Designee page.

     Select [Cost and Payment] privilege; Select [Continue]

On the E-PHI Agreement page:

  1. Read the E-PHI Agreement. Select Accept to authorize the Designee to access or use E-PHI associated with the Plan Sponsor's RDS application or select Decline to return to the Change Designee Privileges page.

    Screen shot of E-PHI Agreement page with emphasis on Accept.

On the Change Designee Privileges Verification page:

  1. Select Confirm to assign privileges to the Designee or select Cancel to return to the Change Designee Privileges page.

     Select [Confirm]

On the Change Designee Privileges Confirmation page:

  1. Select Continue to return to the Assign Designee Payment/Cost Privilege Summary page.

     Select [Continue]

Delete a Designee

Note: If the Designee is assigned to the Vendor, the Vendor assignment must first be removed before deleting the Designee. If the Designee is assigned to one or more Benefit Options but has not reported costs, the assignments must be removed before deleting the Designee. If the Designee has reported costs, the Designee can be deleted without removing the assignments.

To access Step 3: Assign Payment/Cost Privilege to Designee(s), refer to Access the Payment Setup Menu.

On the Assign Designee Payment/Cost Privilege Summary page:

  1. Select the Designee Name link to access Designee Information and delete a Designee.

    Assign Designee Payment/Cost Privilege Summary: Select [Designee Name]

On the Maintain Designee page:

  1. Select Delete Designee to delete a Designee or select Cancel to return to the Assign Designee Payment/Cost Privilege Summary page.

     Select [Delete Designee]

On the Delete Designee Verification page:

  1. Select Confirm to delete this Designee or select Cancel to return to the Maintain Designee page.

     Select [Confirm]

On the Delete Designee Confirmation page:

  1. Select Continue to return to the Assign Designee Payment/Cost Privilege Summary page.

     Select [Continue]

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Complete Step 4: Specify Vendors for Cost Reporting

Watch a step-by-step video on completing Payment Setup Step 4.

Purpose of Step 4: Specify Vendor(s) for Cost Reporting

In Step 4, the Plan Sponsor may choose to assign Vendors for cost reporting. If the Plan Sponsor selects "Yes," they are prompted to identify Vendors and Vendor Designees.

A Vendor may report cost data using Data Entry or Mainframe. A Vendor is required to request a Vendor ID from CMS' RDS Center. Each Vendor ID has a pre-associated cost data submission method as specified by the Vendor. For example, a Vendor wanting to report costs using Mainframe for one application may have Vendor ID A12345 for Mainframe and Vendor ID A56789 for Data Entry.

Establishing a Vendor Cost Reporter with CMS' RDS Center in Step 4 of Payment Setup

To specify a Vendor in Step 4, a Vendor ID is required. The Vendor ID is an identification number assigned to a Vendor by CMS' RDS Center as a form of verification of the Vendor's contract with the Plan Sponsor. To obtain the Vendor ID, contact the Vendor directly for this information. Verify with the Vendor which cost reporting submission method they should use for each application. The Vendor ID may vary depending on whether the Vendor is reporting costs by Data Entry or Mainframe.

A Vendor that wishes to receive Quick Access Reports (QAR) for consolidated cost reporting information may specify one individual who has a current and active RDS Secure Website account to be a Vendor Composite Report Recipient. The Vendor should contact their EDI Representative to facilitate this process. For more information, refer to the Quick Access Report (QAR) User Guide. Vendor Designees are required if a Vendor is reporting by the Data Entry method, but are not required for Mainframe submission.

The Retiree Drug Subsidy (RDS) Community Information Group (CIG) recommends Plan Sponsors assign a Vendor Designee the Report Costs privilege so they can verify that cost reports submitted by Mainframe are accepted.

Specify Vendor(s) for Cost Reporting

To access Step 4: Specify Vendors for Cost Reporting, refer to Access the Payment Setup Menu.

On the Specify Vendor(s) for Cost Reporting page:

An asterisk (*) indicates a required field.

  1. *To specify a Vendor, select the Yes radio button then select Continue to proceed. (If you do not want to specify a Vendor, select No, and then select Continue.) Select Cancel to return to the Payment Setup Menu page without completing this step.

    Note: "Yes" or "No" must be selected to complete this step. If the No radio button is selected, Step 4 is complete and no other information is necessary. If the Yes radio button is selected, additional information about the Vendor is required.

     Select [Continue]

On the Vendor Summary page:

  1. Select the Specify a Vendor link to specify a Vendor to report costs for the application or select Continue to return to the Payment Setup Menu page.

     Select [Specify a Vendor] link

On the Specify Vendor page:

  1. Enter the Vendor ID and then select Go.

    Note: Contact the Vendor directly to obtain their Vendor ID information. Clarify with the Vendor which reporting method the Plan Sponsor wants them to use. The Vendor ID can vary depending on whether the Vendor is reporting costs using Data Entry or Mainframe.

     Enter [Vendor ID]; Select [Go]

On the Specify Vendor page:

  1. If the Vendor ID was found and the information displayed is confirmed, select Assign. Select Modify Search to return to the Specify Vendor page and search for another Vendor ID.

     Select [Assign]

On the Vendor Summary page:

  1. Select Identify Vendor Cost Reporters in the Cost Reporters column or select Identify Cost Reporters from the Actions dropdown menu and select Go.

    Note: For each Vendor assigned, indicate if the Designee is allowed to view cost reports submitted by the specified Vendor. Assigning a Designee to view cost reports submitted by a Vendor is optional; however, answering the question is not. This question only appears if the Vendor reports costs using Mainframe. If the Vendor reports costs using Data Entry, the Identify Vendor Cost Reporters page displays.

     Select [Identify Vendor Cost Reporters] link; or Select [Identify Cost Reporters] from Actions

On the Identify Vendor Cost Reporters page:

  1. If the desired Designee is listed, select the appropriate checkbox next to their name and select Continue (the Vendor Summary page then displays), or select Cancel to return to the Vendor Summary page without completing this step.

    Note: If the Vendor reports costs using Mainframe, Vendor Cost Reporters are allowed to view on the RDS Secure Website those cost reports submitted by the Vendor for the application. If the Vendor reports costs using Data Entry submission, Vendor Cost Reporters are allowed to enter costs on the RDS Secure Website. A Vendor Cost Reporter must be assigned if the Vendor reports costs using Data Entry.

    Screen shot of Identify Vendor Cost Reporters page with emphasis on the checkbox in the Select/Unselect column and the Designee Name in the Designee Name column of the Identify Vendor Cost Reporters table and Continue.

    If the desired Designee is not listed, select the Assign Designee Payment/Cost Privilege link to return to Step 3: Assign Payment/Cost Privilege to Designee(s) to add a Designee.

     Select [Assign Designee Payment/Cost Privilege Summary] link

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Complete Step 5: Assign Benefit Options to Cost Reporters

Purpose of Step 5: Assign Benefit Options to Cost Reporters

In Step 5, the Plan Sponsor is required to report to CMS' RDS Center who is providing the cost data for each Benefit Option.

Assign Benefit Options to Cost Reporters

To access Step 5: Assign Benefit Options to Cost Reporters, refer to Access the Payment Setup Menu.

On the Assign Benefit Options to Cost Reporters page:

  1. Select Assign Benefit Options from the Actions dropdown menu and select Go.

     Select [Assign Benefit Options] from Actions

On the Assign Benefit Options page:

  1. To assign or unassign all listed Benefit Options, select Select All or Unselect All. To assign individual Benefit Options, select the appropriate checkboxes.
  2. Select Continue to proceed or select Cancel to delete the selection and return to the Assign Benefit Options to Cost Reporters page.

     Select a Benefit Option; Select [Continue]

Specify Reporting Method

As part of the Payment Setup process, the Plan Sponsor needs to select the cost reporting method to assign to the Cost Reporter. The cost reporting method informs the RDS Program how the Cost Reporter is going to submit costs to CMS' RDS Center.

Note: A cost reporting method must be specified for each Cost Reporter to complete this step of Payment Setup. The cost reporting method for Vendors has been pre-assigned upon registering with CMS' RDS Center and cannot be modified.

To access Step 5: Assign Benefit Options to Cost Reporters, refer to Access the Payment Setup Menu.

On the Assign Benefit Options to Cost Reporters page:

  1. Select Specify Reporting Method from the Actions dropdown menu and select Go.

     Select [Specify Reporting Method] from Actions

On the Specify Reporting Method page:

  1. Select the corresponding radio button to select Data Entry or Plan Sponsor Mainframe to RDS Center Mainframe through CMS Extranet. Select Continue to proceed or select Cancel to return to the Assign Benefit Options to Cost Reporters page.

    Screen shot Specify Reporting Method page with emphasis on reporting methods and Continue.

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Complete Step 6: Final Review to Complete Payment Setup

Purpose of Step 6: Final Review to Complete Payment Setup

In Step 6, the Plan Sponsor reviews and confirms Payment Setup. View details of the selected Payment Setup assignments by selecting View Payment Setup Options on the Payment Setup Menu page at any time.

Final Review to Complete Payment Setup

To access Step 6: Final Review to Complete Payment Setup, refer to Access the Payment Setup Menu.

On the Review to Complete Payment Setup page:

  1. Review each Payment Setup step to complete the final review.
  2. If a step is "Incomplete," select the corresponding link to proceed to that step and complete it.
  3. Select Submit Payment Setup after all steps are complete or select Cancel to return to the Payment Setup Menu.

     Select [Submit Payment Setup]

On the Successful Payment Setup page:

  1. Select Continue to return to the Payment Setup Menu page.

     Select [Continue]

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