This section provides an overview of the following topics related to Reconciliation: Manage Final Costs:
The purpose of Reconciliation: Manage Final Costs is to allow the Account Manager or Designee with the Request Payment privilege to monitor the submission of final cost reports submitted by all reporting sources for the entire application.
By completing this step, the Plan Sponsor indicates that final cost reporting is complete for the application, thus disallowing any further submission of final cost reports. The Plan Sponsor may return to this step at a later time to allow for additional cost reporting as necessary.
After Reconciliation is initiated, all cost reports submitted to CMS' RDS Center are considered final cost reports. Final cost reports are only accepted after Reconciliation: Finalize Covered Retirees is complete, the Application Status is "Reconciliation Cost Reporting Opened," and Payment Setup is complete. Any Connect:Direct final cost reports submitted when the application is not in this status or when Payment Setup is incomplete are rejected by CMS' RDS Center with a status of "Connect:Direct: Errors Detected."
Note: Payment Setup can be revisited while cost reporting is open.
Plan Sponsors may complete this Reconciliation step when at least one final cost report has been submitted for a Benefit Option if interim payments have not been requested for any other Benefit Option. If a Plan Sponsor received an interim payment, they must report final costs for each Benefit Option that received this payment to enable the "Complete Reporting" button. When entering costs on the RDS Secure Website, the "Complete Reporting" button remains disabled while any final cost reports are in "Data Entry: Saved" status.
When final cost reporting is complete, Reconciliation: Manage Final Costs is marked "Complete" and the status of the application changes to "Reconciliation Cost Reporting Closed." After Reconciliation: Manage Final Costs is complete, Data Entry cost reporting is prohibited on the RDS Secure Website and any Connect:Direct cost reports submitted to CMS' RDS Center are rejected.
When Reconciliation: Manage Final Costs is complete, the "Allow Reporting" button becomes enabled in the event the Plan Sponsor needs to allow for additional cost updates after initial completion of this step. When reporting is allowed, Reconciliation: Manage Final Costs is marked "Incomplete", as are any subsequent Reconciliation steps that may have been completed, and the Application Status changes to "Reconciliation Cost Reporting Opened." When the application is returned to this status, Connect:Direct final cost reports will again be accepted by CMS' RDS Center and the RDS Secure Website allows final cost reports to be entered.
Only the Designee with the Request Payment privilege or the Account Manager can close or reopen final cost reporting in this Reconciliation step. If the Account Manager has the Report Costs privilege for the application and has been assigned the Data Entry method, they may enter final cost reports for any Benefit Options they were assigned in Payment Setup. Account Managers can view all cost reports regardless of privilege.
The Authorized Representative has "View Only" access to this Reconciliation step.
The Account Manager, Authorized Representative, and Designee with the Request Payment privilege may access this step any time after Reconciliation is initiated to view the most current reported costs, historical cost reports, and an Audit Trail of all cost reporting events relating to a Benefit Option.
To ensure the successful submission of final cost reports, Plan Sponsors should consider the following:
The Account Manager and Designee with the Report Costs privilege may view the Audit Trail which includes interim cost reports and final cost reports.
As with interim cost reporting, final cost reports are submitted to CMS' RDS Center by two methods: Connect:Direct submission or Data Entry using the RDS Secure Website.
During Payment Setup, the Account Manager or Authorized Representative specified the reporting method for Cost Reporters not associated with a Vendor. For more information, refer to Payment Setup.
Vendors and Plan Sponsors are the two types of sources that can report final cost data. Each source's cost report is treated as separate and distinct from the final cost report submitted by another source. If multiple sources successfully report final cost data for a Benefit Option, the final cost data is aggregated to determine the final subsidy amount. The Plan Sponsor has the ability to reject an individual cost report in Reconciliation: Review Final Costs and exclude that cost report from the final Reconciliation payment request if duplicate cost data is reported.
Only the Account Manager, Authorized Representative, and Designee with the Request Payment privilege may view the final costs submitted by all reporting sources.
An Account Manager assigned the Report Costs privilege and Data Entry Reporting Method is considered a Cost Reporter for the Plan Sponsor. Account Managers may only enter or edit costs reported directly by the Plan Sponsor for the Benefit Options specified in Payment Setup. Account Managers cannot modify costs reported by a Vendor reporting source. If the Plan Sponsor submitted costs by Connect:Direct submission, the Account Manager cannot modify the cost report.
Designees with the Report Costs privilege may be assigned to a Vendor or the Plan Sponsor in Payment Setup. If assigned to a Vendor, the Designee may access only the costs reported by that Vendor. The Designee does not have access to cost reports for any other Vendor or the Plan Sponsor. The Vendor must currently be assigned to the Benefit Option in Payment Setup for a Vendor Designee to access the Vendor's reported costs. If the Vendor has specified the Data Entry method for reporting final costs, the Designee may also enter or modify costs on behalf of the Vendor. If the Vendor has specified the Connect:Direct method for reporting final costs, the Designee has "View Only" access to the Vendor's Connect:Direct reports.
A Designee Cost Reporter that is not assigned to a Vendor in Payment Setup is considered a Plan Sponsor Designee and does not have access to any Vendor cost reports. The Designee has access to the Plan Sponsor cost reports for the Benefit Options assigned to the Designee only. If the Connect:Direct method is used, the Designee has "View Only" access to those reports submitted via Connect:Direct transmission by the Plan Sponsor. If the data entry method is used, the Designee is permitted to enter, modify, and submit final cost figures on behalf of the Plan Sponsor for the assigned Benefit Options.
For information on preparing final costs, refer to Prepare Cost Data.
Vendors must register with CMS' RDS Center to report costs and specify their reporting method. If reporting costs by Connect:Direct submission, an RDS Electronic Data Interchange (EDI) Representative assists the Vendor in establishing the proper connection, file names, and file structure. This setup must be completed once for each Vendor. Before transmitting data to CMS' RDS Center using Connect:Direct, contact CMS' RDS Center for information about how to send test files to ensure that proper connectivity is established.
A Vendor file may contain cost reports for multiple Plan Sponsors, applications, and Benefit Options. The Vendor must be assigned to the proper Benefit Option in Payment Setup for CMS' RDS Center to accept a Connect:Direct cost report from a Vendor. The Plan Sponsor can assign a Designee to a Vendor reporting Connect:Direct costs in Payment Setup. This privilege allows the Designee to view all cost reports sent by that Vendor which did not have critical errors.
Plan Sponsors that report final costs by Connect:Direct submission must contact CMS' RDS Center to establish the proper connection, file names, and file structure. A Connect:Direct file reported by a Plan Sponsor may contain cost reports for multiple applications and Benefit Options, but only for a single Plan Sponsor. For CMS' RDS Center to accept a Connect:Direct cost report, the Connect:Direct method must be assigned to the Plan Sponsor's Cost Reporter (Account Manager or Designee) in Payment Setup, and the Plan Sponsor's Cost Reporter must be assigned to the proper Benefit Option.
The overall Connect:Direct cost report file format is as follows:
Note: File Header (FHDR) information and File Creation Time must be preceded by leading zeroes if time is less than 8 bytes (to prevent time as "8:11:11").
For more information about the Connect:Direct cost report file format, review the Connect:Direct Cost Report Copybooks.
For more information about the Connect:Direct cost file, review the Sample Connect:Direct Cost File.
More than one Application ID may be submitted in the same file, but they must be separated by an Application Trailer and start with another application Header. Finally, multiple months of cost data may be submitted for the same Unique Benefit Option Identifier (UBOI), but they must be in separate detail lines.
Files may contain interim cost data and final cost data for separate applications. When submitting final cost data, all months in the plan year must be submitted between a single set of Application Header and Application Trailer records.
There is no limit to the number of final cost reports that may be submitted while the Application Status is "Reconciliation Cost Reporting Opened." If multiple files are sent by a reporting source, the most recent error-free cost report is used to reflect cost figures for all months on the RDS Secure Website.
Final cost reports must include cost data for every month in the plan year. Zero dollars must be reported for months where no valid cost data was incurred. In addition, zero dollars must be reported for a plan month if no eligible retiree has coverage effective dates that fall within the plan month.
Final costs reported by multiple reporting sources for the same Benefit Options are summed when calculating the final subsidy amount if the cost reports pass system edits and are accepted by the Plan Sponsor in Reconciliation: Review Final Costs.
An accurate cost report is one that:
A Vendor or a Plan Sponsor reporting final costs by Connect:Direct submission must submit aggregated retiree cost data per Benefit Option for all application plan months. Cost data sent using Connect:Direct is viewable on the RDS Secure Website; however, the cost data reported via Connect:Direct cannot be changed using the RDS Secure Website. To revise cost data originally submitted by Connect:Direct, the revised cost data files must be resubmitted using the Connect:Direct connection. This new data displays on the RDS Secure Website.
If the Connect:Direct final cost report was received and had no critical errors, it displays on the RDS Secure Website approximately 24 to 48 hours after it was sent. Accepted cost reports display with a status of "Connect:Direct: Submitted." Cost reports that are rejected for non-critical errors display with a status of "Connect:Direct: Errors Detected."
Generally, if the Connect:Direct file was received, and there were critical errors that prevented it from being processed, CMS’ RDS Center will email the submitter to alert them to the errors. As a result, the cost reports are not viewable on the RDS Secure Website.
The following error conditions are considered critical:
Important: In order for a Vendor Technical Contact to be able to discuss application-specific information, they must be assigned to the application and complete user registration.
Note: Errors are viewable through Quick Access Reports (QAR).
Cost reports that are rejected by CMS' RDS Center for non-critical errors receive a status of "Connect:Direct: Errors Detected" and are viewable from the Benefit Option Final Costs list. Specific information about the file, cost report, and the corresponding errors can be viewed on the Audit Trail.
A cost report rejected by CMS' RDS Center is not included in the final Reconciliation payment request. However, if a final cost report was previously accepted for the Benefit Option from the same source or a different source, the Plan Sponsor may choose to proceed with Reconciliation using the last successfully submitted final cost report.
The following error conditions cause a Connect:Direct cost report to be placed in "Connect:Direct: Errors Detected" status:
Data Entry through the RDS Secure Website requires a user to access the RDS Secure Website and manually enter the aggregated final cost data per Benefit Option. Final cost figures must be entered and saved for each plan month to submit the final cost report. Only submitted final cost reports may be included in the final Reconciliation payment request.
If interim Gross Retiree Costs were previously entered and submitted on the RDS Secure Website by the Cost Reporting source, the last submitted interim cost figures initially appear as final costs when Reconciliation is initiated. The status of the final cost report appears as "Data Entry: Update/Entry Required." The Cost Reporter for the Reporting Source must save the costs for all plan months to submit the final cost report.
After all plan months have a status of "Saved," the Cost Reporter submits the final cost report. The Cost Report status changes to "Data Entry: Submitted." The Cost Reporter may return to modify costs for any plan month while final cost reporting is open. When modifications are saved, the plan month appears as "Updated" and the status of the cost report is "Data Entry: Saved." The Cost Reporter must re-submit the cost report for the changes to be included in the final Reconciliation payment request. The Plan Sponsor is unable to complete final cost reporting if any cost reports are left in "Data Entry: Saved" status.
During final cost reporting, cost figures are validated when saved on the RDS Secure Website, submitted on the RDS Secure Website, or submitted by Connect:Direct submission.
Some Cost Validation Edits look at the compatibility of the reported data. For example, the reported Threshold Reduction and Limit Reduction cannot exceed the reported Gross Retiree Costs. Other Cost Validation Edits apply maximum thresholds to the final cost figures based on the finalized Covered Retiree List. Edits are applied to individual cost reports and the Benefit Options in total during final cost reporting.
A Cost Validation Edit failure during final cost reporting may result in either an error or warning. If a cost report fails a Cost Validation Edit, an error is usually generated. A warning occurs if a Benefit Option's costs fail to pass Cost Validation Edits due to multiple sources reporting final costs for the Benefit Option.
If costs fail a Cost Validation Edit resulting in an error, the cost figures are not accepted.
If an error occurs when saving cost figures for a plan month, an error message is displayed, and the user must resolve the error before the data can be saved on the RDS Secure Website.
If a cost validation error is returned when submitting the final cost report on the RDS Secure Website, the error must be resolved before the system accepts the cost report.
If a cost validation error is detected in a Connect:Direct cost report, the cost report is rejected with a status of "Connect:Direct: Errors Detected."
Note: A warning does not prevent the cost report from being saved, submitted, or accepted by CMS' RDS Center in Reconciliation: Manage Final Costs.
Cost Validation Edits are again applied to the final cost figures accepted in Reconciliation: Review Final Costs. All Cost Validation Edit failures result in errors in Reconciliation: Review Final Costs. In addition to examining an individual cost report and Benefit Option, all costs reported for an application are examined in total to detect failures to coordinate individual retiree costs across the application.
If an error was caused by duplicate reporting, the Plan Sponsor may choose to reject an individual cost report to resolve the error. If the error was caused by the reporting of inaccurate final costs, the Plan Sponsor must reopen final cost reporting, and final cost reports must be re-submitted.
The Benefit Option Cost Reporting Source List table displays "Status of Last Report." This status refers to the last cost report saved or submitted by a reporting source for each Benefit Option. The status of individual cost reports is displayed in the Audit Trail.
When Reconciliation is initiated the "Status of Last Report" reflects one of the following statuses:
If a Connect:Direct Cost Report is received after Reconciliation is initiated and before final cost reporting is opened, the "Status of Last Report" is "Connect:Direct: Errors Detected."
During Reconciliation final cost reporting, the status of the last cost report reflects one of the following statuses:
After final cost reporting is closed, and Reconciliation: Manage Final Costs is complete, the Account Manager or Designee with the Request Payment privilege must review the final cost data submitted for each Benefit Option to prepare the final Reconciliation payment request. Final cost reports with a status of "Data Entry: Submitted" and "Connect:Direct: Submitted" in this step are reviewed in Reconciliation: Review Final Costs and may be included in the final Reconciliation payment request. Reviewing costs in Reconciliation: Review Final Costs will change the "Status of Last Report" in Reconciliation: Manage Final Costs.
If the "Status of Last report" in Reconciliation: Manage Final Costs is "Connect:Direct: Errors Detected," previously accepted final costs may be eligible for review in Reconciliation: Review Final Costs. If the reporting source previously submitted final costs without error, the last cost report accepted by CMS' RDS Center is reviewed by the Plan Sponsor in Reconciliation: Review Final Costs and may be included in the final Reconciliation payment request.
The following cost reporting review statuses result from the actions taken in Reconciliation: Review Final Costs:
Note: If a Connect:Direct final cost report is submitted after Reconciliation: Review Final Costs is closed, the "Status of Last Report" appears as "Connect:Direct: Error Detected." If a final cost report was previously submitted without errors, the review status appears in the Audit Trail.
Completing Reconciliation: Review and Submit Reconciliation Payment Request changes the "Status of Last Report" of all cost reports accepted in Reconciliation: Review Final Costs to "Included in Final Payment Request" if the status is not "Connect:Direct: Errors Detected."
The following table describes the last cost report statuses.
Cost Report Statuses |
|
Cost Report Status |
Description |
Data Entry: Saved |
This status pertains only to cost reports entered on the RDS Secure Website and indicates that the last final cost report was saved but not yet submitted by the reporting source. At least one Plan Month must be entered. |
Data Entry: Entry/Update Required |
If an interim cost report was saved or submitted on the RDS Secure Website, the status of the last final cost report appears as "Data Entry: Update/Entry Required" when Reconciliation is initiated. If Gross Retiree Costs were reported, the interim cost figures are available for update while final cost reporting is open. When final cost figures have been saved for all plan months, the status of the last cost report changes to "Data Entry: Saved" and the final cost report can be submitted. |
Data Entry: Submitted |
This status pertains only to cost reports entered on the RDS Secure Website and indicates that the final cost report from this reporting source has been submitted and can now be included in the Reconciliation payment request. |
Connect:Direct: Submitted |
This status pertains only to cost reports received using Connect:Direct file transfer and indicates that no errors were detected and that the final cost report for this reporting source is now available to be included in the Reconciliation payment request. |
Connect:Direct: Errors Detected |
This status pertains only to cost reports received using Connect:Direct file transfer and indicates that at least one error was detected in the last submitted cost report from this reporting source. Reconciliation may proceed if a final cost report was previously submitted without error for the Benefit Option by the same source, or final costs have been submitted for the Benefit Option by a different source or method. |
No Reports |
This status indicates that no cost reports have been processed (Connect:Direct) or saved/submitted (Data Entry) for the Benefit Option by this reporting source. |
No Final Reports |
This status pertains only to cost reports received using Connect:Direct file transfer. This status indicates that interim costs were previously reported by the reporting source for the Benefit Option; however, the reporting source has not yet reported final costs. |
Reviewed: Reject |
The Account Manager or Designee with the Request Payment privilege rejected this cost report but has not yet completed the review of final cost reports for the application. |
Reviewed: Undo Reject |
The Account Manager or Designee with the Request Payment privilege previously rejected this cost report, and the cost report is currently accepted. This status displays when the review of final cost reports for the application is not yet complete. |
Review Complete: Accepted |
The Account Manager or a Designee with the Request Payment privilege completed the review of final cost reports for the Benefit Option and has accepted this cost report. |
Review Complete: Rejected |
The Account Manager or a Designee with the Request Payment privilege completed the review of final cost reports for the Benefit Option and has rejected this cost report. |
Included in Final Payment Request |
This status indicates the cost report was used to calculate the final payment request amount agreed to in Reconciliation: Review and Submit. |
After this step is complete, Reconciliation: Manage Final Costs is marked with a green check in the Left Navigation menu of the application to indicate that the step is complete. Data Entry final cost reports can no longer be entered and/or edited on the RDS Secure Website. Connect:Direct final cost reports that are submitted will now be rejected and appear in the Cost Reporting Audit Trail with a status of "Connect:Direct: Errors Detected." The status of the application changes to "Reconciliation Cost Reporting Closed."
This section provides step-by-step instructions to complete the following tasks in Reconciliation: Manage Final Costs:
View/Enter/Update Costs in Reconciliation: Manage Final Costs
To access the RDS Secure Website and navigate to the Dashboard page, review instructions to access the RDS Secure Website.
On the Dashboard page:
Select the Application ID for which you want to view Reconciliation.
On the Application Overview page:
Select Reconciliation.
On the Reconciliation page:
Select Manage Final Costs.
On the Manage Final Costs page:
Select View/Enter/Update Costs in the Actions column of the Benefit Option Cost Reporting Sources List table and select Go.
Note: Only the Account Manager or Designee with Report Costs privilege for a particular Benefit Option may modify cost amounts.
On the Benefit Option Final Costs page:
The Benefit Option Final Cost Report table lists the most recent final costs reported for each month of the Plan Year. The Submit Costs button is enabled after costs are updated for at least one Month/Year. To enter or modify costs, select Update Costs for the appropriate Month/Year. There is no limit to the number of final cost reports that may be submitted by a Cost Reporter.
On the Update Benefit Option Final Costs page:
An asterisk (*) indicates a required field.
Enter the modified amount(s) in the following fields:
Select Save to store the information and proceed, or select Cancel to disregard any entry and return to the Benefit Option Final Costs page.
On the Benefit Option Final Costs page:
Select Submit Costs to close final cost reporting or select Cancel to return to the Manage Final Costs page without completing this step. Note: you can view the audit trail of Benefit Option cost reports from the Manage Final Costs page.
View Audit Trail in Reconciliation: Manage Final Costs
To access the RDS Secure Website and navigate to the Dashboard page, review instructions to access the RDS Secure Website.
On the Dashboard page:
Select the Application ID for which you want to view Reconciliation.
On the Application Overview page:
Select Reconciliation.
On the Reconciliation page:
Select Manage Final Costs.
On the Manage Final Costs page:
Select View Audit Trail in the Actions column of the Benefit Option Cost Reporting Sources List table and select Go.
On the Audit Trail of Benefit Option Cost Reports page:
Select View Cost Report in the Actions column of the Audit Trail of Benefit Option Cost Reports table and select Go, or select Cancel to return to the Manage Final Costs page.
On the Benefit Option Costs page:
Review the Benefit Option Cost Reporting Sources List table. When your review is complete, select Cancel to return to the Manage Final Costs page.
Complete Reconciliation: Manage Final Costs
To access the RDS Secure Website and navigate to the Dashboard page, review instructions to access the RDS Secure Website.
On the Dashboard page:
Select the Application ID for which you want to view Reconciliation.
On the Application Overview page:
Select Reconciliation.
On the Reconciliation page:
Select Manage Final Costs.
On the Manage Final Costs page:
Select Complete Reporting.
The Manage Final Costs page refreshes to display a Success message stating that Reconciliation Cost Reporting is closed for the application. The Complete Reporting button is replaced by the Allow Reporting button. Manage Final Costs is marked with a green check mark in the Left Navigation menu.
To access the RDS Secure Website and navigate to the Dashboard page, review instructions to access the RDS Secure Website.
On the Dashboard page:
Select the Application ID for which you want to view Reconciliation.
On the Application Overview page:
Select Reconciliation.
On the Reconciliation page:
Select Manage Final Costs.
On the Manage Final Costs page:
Select Allow Reporting.
The Manage Final Costs page refreshes to display a Success message stating that Reconciliation Cost Reporting is open for the application. The Allow Reporting button is replaced by the Complete Reporting button. The green check mark is removed from Manage Final Costs in the Left Navigation menu.
Return to Reconciliation: Finalize Covered Retirees | Continue to Reconciliation: Review Final Costs