Reconciliation: Review And Submit Reconciliation Payment Request

User Roles:

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Program Components:

Reconciliation

Overview

This section provides an overview of the following topics:

Introduction to Reconciliation: Review and Submit

The purpose of Reconciliation: Review and Submit is to allow the Authorized Representative to review and submit or reject the Reconciliation final payment request.

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User Roles

Reconciliation: Review and Submit can only be completed by the Authorized Representative. The Account Manager or Designee with the Request Payment privilege will have “View Only” access to this step.

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Communication for Reconciliation: Review and Submit

After Reconciliation: Review and Submit is complete and CMS' RDS Center completes the Reconciliation Determination process, CMS' RDS Center will send a Reconciliation Determination Email to the Authorized Representative, Account Manager, and Designee with the Submit Appeal privilege.

If you do not receive this email, contact CMS' RDS Center.

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Timing & Dependencies

Reconciliation: Review and Submit cannot be started until all previous Reconciliation steps have been completed.

To guarantee a correct Reconciliation payment request, the Authorized Representative may revisit Reconciliation: Review and Submit as frequently as needed, before the step is completed and before the Reconciliation Deadline.

All Reconciliation steps up to and including Reconciliation: Review and Submit must be completed before the application's Reconciliation Deadline.

IMPORTANT: When a user account becomes locked after multiple failed login attempts for any reason—invalid Login ID, Password, or MFA code, or any combination of these—

  • CMS’ RDS Center is prohibited by Federal Security Regulations to identify which login requirements were entered incorrectly.
  • The user is now required to change their password
  • A password can only be changed once in a 24-hour period; 
  • Users cannot change their password multiple times in a single day. If a user changes their password and then locks their account on the same day, the user cannot change their password to unlock their account until 24 hours have passed.

Due to security reasons, the RDS Center does not have the authority to unlock accounts for Secure Website users. As a result, the 24 hours IMMEDIATELY PRECEDING a deadline can be very difficult to obtain remediation regarding account login issues, potentially resulting in a missed deadline and possible loss of subsidy. 

After Reconciliation: Review and Submit is complete, it cannot be changed.

CMS' RDS Center processes Reconciliation payment requests after the payment determination is made. All Reconciliation payment requests are processed as timely as possible. Most payment requests are processed within 30 calendar days from the date of submission of the request and are sent using Electronic Funds Transfer (EFT).

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Rejecting Reconciliation: Review and Submit

If the cost summary and resulting subsidy amount is incorrect, or the banking information is incorrect, the Authorized Representative must reject the Reconciliation payment request in Reconciliation: Review and Submit.

Rejecting the Reconciliation payment request based on the subsidy amount will change the following steps to "Incomplete": Reconciliation: Review Final Costs and Reconciliation: Banking Information. Rejecting the Reconciliation payment request based on the banking information will change Reconciliation: Banking Information to "Incomplete." These steps must be updated and recompleted by the Account Manager, Designees with the Request Payment privilege, and Cost Reporters before Reconciliation: Review and Submit can be recompleted.

Reminder: All Reconciliation steps up to and including Reconciliation: Review and Submit must be completed before the application's Reconciliation Deadline.

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Negative Reconciliation Payment Requests

The final Covered Retiree List and Cost Reports submitted by the Plan Sponsor may result in a negative Reconciliation payment request. A negative Reconciliation payment request is considered an overpayment. In such cases, CMS will initiate immediate overpayment recovery action. For more information about overpayments, refer to Satisfy an Overpayment.

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What Happens After This Reconciliation Step Is Complete?

After Reconciliation: Review and Submit is complete, the step is marked with a green check in the Left Navigation menu. The status of the application will change to "Reconciliation Request Completed." On the Dashboard page, the application will be removed from the In Progress view and will display in the Completed view.

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Step-by-Step Instructions

This section provides step-by-step instructions to complete the following tasks:

Approve Reconciliation: Review and Submit

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

On the Dashboard page:

  1. Select In Progress to view a list of all Applications in progress.
  2. Select the Application ID for which you want to view Reconciliation.

    Dashboard page with sample data. In Progress and Application ID links are highlighted.

On the Application Overview page:

  1. Select Reconciliation.

    Application Overview page with sample data. Reconciliation is highlighted in left nav.

On the Reconciliation page:

  1. Select Review and Submit.

    Reconciliation page with sample data. Review and Submit is highlighted in left nav.

On the Review and Submit page:

  1. Review the Amount of Reconciliation Payment Request and the Banking Information reviewed and/or updated in Reconciliation: Banking Information. The Amount of Reconciliation Payment Request will match the Net Subsidy Amount displayed in the Review Subsidy table. Negative dollar amounts display in parenthesis and red text.

    Note: If Banking Information was changed during Reconciliation, the following text will display:

    • Did banking information change since Reconciliation was initiated? Yes.

       

    To view all Banking Information and verify the changes, select Manage Banking Information.

    Review and Submit page with sample data. Amount of Reconciliation Payment Request and Net Subsidy Amount are highlighted.

  2. Select the plus sign (+) to expand the Benefit Option Summary table to view how each Benefit Option contributes to calculation of the Amount of Reconciliation Payment Request.

    Review and Submit page with sample data. Plus sign button is highlighted.

    Review and Submit page with sample data. Benefit Option Summary section is expanded, and Benefit Option Summary table is highlighted.

  3. Review the Signature of Plan Sponsor Authorized Representative text box – this is the Reconciliation Agreement.

    Review and Submit page with Signature of Plan Sponsor Authorized Representative section highlighted.

  4. Select the Banking Information is correct? YES radio button to certify the Banking Information for the application.
  5. Select Subsidy amounts are correct? YES radio button to certify the subsidy amounts for the application.

    Review and Submit page with Banking Information and Subsidy amounts radio buttons highlighted.

  6. Select the I have read and agree with the Reconciliation Agreement checkbox and select Submit to validate the Reconciliation payment request and complete Reconciliation.

    Review and Submit page with Reconciliation Agreement checkbox selected. Reconciliation Agreement checkbox and Submit button are highlighted.

On the Reconciliation page:

  1. The page refreshes to display a Success Message stating that Reconciliation has been completed for the application. The Review and Submit Completed Date field, Review and Submit Completed By field, and Review and Submit Status field are updated to reflect completion of Reconciliation

    Note: CMS’ RDS Center recommends that you print this page for your records.

  2. Select Reconciliation.

    Review and Submit page with Success message, sample data, and Reconciliation in left nav highlighted.

On the Reconciliation page:

  1. All Reconciliation steps are marked with a green check in the Left Navigation menu to indicate that the Reconciliation Payment Request has been submitted and that Reconciliation is complete for this application.

    Note: CMS’ RDS Center recommends that you print this page for your records.

    Reconciliation page with sample data. All Reconciliation steps with complete status indicators in left nav are highlighted.

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Reject Reconciliation: Review and Submit

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

On the Dashboard page:

  1. Select In Progress to view a list of all Applications in progress.
  2. Select the Application ID for which you want to view Reconciliation.

    Dashboard page with sample data. In Progress and Application ID links are highlighted.

On the Application Overview page:

  1. Select Reconciliation.

    Application Overview page with sample data. Reconciliation is highlighted in left nav.

On the Reconciliation page:

  1. Select Review and Submit.

    Reconciliation page with sample data. Review and Submit is highlighted in left nav.

On the Review and Submit page:

  1. Review the Amount of Reconciliation Payment Request and the Banking Information reviewed and/or updated in Reconciliation: Banking Information. The Amount of Reconciliation Payment Request will match the Net Subsidy Amount displayed in the Review Subsidy table. Negative dollar amounts display in parenthesis and red text.

    Note: If Banking Information was changed during Reconciliation, the following text will display:

    • Did banking information change since Reconciliation was initiated? Yes.

       

    To view all Banking Information and verify the changes, select Manage Banking Information.

    Review and Submit page with sample data. Amount of Reconciliation Payment Request and Net Subsidy Amount are highlighted.

  2. Select the plus sign (+) to expand the Benefit Option Summary table to view how each Benefit Option contributes to calculation of the Reconciliation final payment request.

    Review and Submit page with sample data. Plus sign button is highlighted.

    Review and Submit page with sample data. Benefit Option Summary section is expanded, and Benefit Option Summary table is highlighted.

  3. Review the Signature of Plan Sponsor Authorized Representative text box – this is the Reconciliation Agreement.

    Review and Submit page with Signature of Plan Sponsor Authorized Representative section highlighted.

  4. Select the Banking Information is correct? NO radio button to reject the Banking Information, if applicable.
  5. Select the Subsidy Amounts are correct? NO radio button to reject the subsidy amounts, if applicable.

    Review and Submit page with Banking Information and Subsidy amounts radio buttons highlighted.

  6. Select the I have read and agree with the Reconciliation Agreement checkbox and select Submit to reject the Reconciliation payment request.

    Review and Submit page with Reconciliation Agreement checkbox selected.  Reconciliation Agreement checkbox and Submit button are highlighted.

If you rejected Banking Information only:

  1. On the Rejection due to Incorrect Banking Information warning, select Accept to confirm that the information is incorrect, or select Cancel to return to the Review and Submit page.

    Rejection due to Incorrect Banking Information warning pop-up with Accept button highlighted.

If you rejected Subsidy Amounts AND Banking Information OR Subsidy Amounts only:

  1. On the Rejection due to Incorrect Subsidy Amounts warning, select Accept to confirm that the information is incorrect, or select Cancel to return to the Review and Submit page.

    Rejection due to Incorrect Subsidy Amounts warning pop-up with Accept button highlighted.

On the Reconciliation page:

  1. The Left Navigation menu refreshes and the green check marks are removed to indicate the Reconciliation steps that must be recompleted:

    Reconciliation page with sample data. Last three steps of Reconciliation with no status indicators in left nav are highlighted.

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Return to Reconciliation: Banking Information