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Quick Access Reports (QAR)

Supplemental Information

Step 6: Manage Submission of Final Cost Reports

User Roles:

AM

D

Program Components:

Reconciliation

Overview

This section provides an overview of the following topics related to Step 6: Manage Submission of Final Cost Reports:

Introduction to Step 6: Manage Submission of Final Cost Reports

The purpose of Step 6: Manage Submission of Final Cost Reports is to allow the Account Manager or Designee with Request Payment privilege to monitor the submission of final cost reports submitted by all reporting sources for the entire application.

By completing Step 6, the Plan Sponsor is indicating that final cost reporting is complete for the application thus disallowing any further submission of final cost reports. A Plan Sponsor may return to Step 6 at a later time to allow for additional cost reporting as necessary.

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Timing for Step 6: Manage Submission of Final Cost Reports

After Reconciliation is initiated in Step 1: Initiate Reconciliation, all cost reports submitted to CMS' RDS Center are considered final cost reports. Final cost reports are only accepted after Step 5: Start Preparation of Reconciliation Payment Request is complete, the Application Status is "Reconciliation Cost Reporting Opened," and Payment Setup is complete. Any Mainframe final cost reports submitted when the application in not in this status or when Payment Setup is incomplete are rejected by CMS' RDS Center and display in Step 6: Manage Submission of Final Cost Reports with a status of "Mainframe: Errors Detected."

Note: Payment Setup can be revisited while cost reporting is opened. Step 6 of Payment Setup will become incomplete if changes are made Step 6 of Payment Setup and Step 2 of Reconciliation must be complete to report costs. 

Step 6 cannot be started until Steps 1 through 5 have been completed. Plan Sponsors may complete Step 6 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 Options. 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 in Step 6. 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, Step 6 is marked "Complete" and the status of the application changes to "Reconciliation Cost Reporting Closed." After Step 6 is complete, Data Entry cost reporting is prohibited on the RDS Secure Website and any Mainframe cost reports submitted to CMS' RDS Center are rejected. When Step 6 is complete, the "Allow Reporting" button becomes enabled. When reporting is allowed, Step 6 is marked "Incomplete" and the Application Status changes to "Reconciliation Cost Reporting Opened." When the application is returned to this status, Mainframe final cost reports will again be accepted by CMS' RDS Center and the RDS Secure Website allows final cost reports to be entered.

Step 6 must be marked "Complete" on the Reconciliation Checklist to proceed to the remaining steps.

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User Role Responsibilities for Step 6: Manage Submission of Final Cost Reports

Only the Account Manager or Designee with Request Payment privilege can close or reopen final cost reporting in Step 6: Manage Submission of Final Cost Reports. 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.

Designee Cost Reporters do not have access to the Reconciliation Checklist and Step 6. Designees with Report Costs privilege must access cost reporting through the Final Costs action available on the Application List page.

The Authorized Representative has "View Only" access to Step 6.

The Account Manager, Authorized Representative, and Designee with 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.

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Managing Final Cost Reporting in Step 6

To ensure the successful submission of final cost reports, Plan Sponsors should consider the following:

  • If a Mainframe cost report is submitted before Step 5: Start Preparation of Reconciliation Payment Request is complete, the cost report is rejected and the status of the Mainframe cost report changes to "Mainframe: Errors Detected."
    • In this case, the Mainframe cost report must be resubmitted after final cost reporting is opened with the completion of Step 5.
  • If Cost Reporters are submitting Mainframe final cost reports, the Plan Sponsor should monitor Step 6: Manage Submission of Final Cost Reports while cost reporting is open to ensure that final cost files are received and accepted. Quick Access Reports (QAR) may be used to monitor cost reporting activities.
  • Mainframe cost reports are rejected by CMS' RDS Center for data inconsistencies and edit failures.
  • When a Mainframe cost report is rejected by CMS' RDS Center, the status of the cost report changes to "Mainframe: Errors Detected."
  • The Plan Sponsor must work with the Cost Reporter to eliminate any data discrepancies and resubmit the final cost report.
  • If a final cost report was previously accepted by CMS' RDS Center, the Plan Sponsor may proceed with Reconciliation using the previously reported final costs.
  • If a Mainframe cost report is submitted after Step 6 is complete, the cost report is rejected and the status of the Mainframe cost report changes to "Mainframe: Errors Detected." It is suggested that the Account Manager check to see if costs have changed and reopen costs and resubmit them if necessary.
    • A Warning appears on the Reconciliation Checklist instructing the Plan Sponsor to return to Step 6 to review the rejected cost report in the Cost Report Audit Trail.
    • If a final cost report was previously accepted by CMS' RDS Center, the Plan Sponsor may proceed with Reconciliation using the previously reported final costs.
  • If cost reports are entered on the RDS Secure Website, the Plan Sponsor should monitor the status of each cost report.
    • If interim costs were previously entered on the RDS Secure Website and included in an interim payment request, the final cost report has a status of "Data Entry: Update Entry Required." A cost report may be left in this status only if final costs for the same Benefit Option are reported by another source.
    • If final costs are being reported using the same method as interim costs, the Cost Reporter must enter or re-save costs for each plan month and submit the final cost report. After final costs are saved for all plan months, the status of the final cost report changes to "Data Entry: Saved."
    • A cost report cannot be left in this status. The Cost Reporter must submit the final cost report. After the final cost report is submitted, the status of the final cost report changes to "Data Entry: Submitted."
  • Plan Sponsors are required to have internal supporting drug cost details and summarized data validating all final cost data reported.
  • Plan Sponsors should compare the summarized data with the final cost reports already submitted to ensure that the final cost data included in the Reconciliation payment request is accurate.

Submitting Accurate Cost Reports

An accurate cost report is one that:

  • Includes only eligible costs incurred for the Qualifying Covered Retirees, their Subsidy Periods, and Benefit Options agreed upon in the finalized Covered Retiree List (CRL).
    • Note: Gross Retiree Costs are eligible costs aggregated by plan month based on the incurred date. To be eligible, the drug cost(s) must be:
      • Covered under Medicare Part D and not reimbursable under Medicare Part B.
      • Incurred on or within the Subsidy Period Effective Date and Termination Date listed on the CRL.
      • Paid by the plan, the QCR through out-of-pocket co-pay or deductible, or a combination of the two.
  • Has accurately calculated Gross Retiree Costs based upon the incurred date of claims.
  • Has accurately applied the Cost Threshold and Cost Limit to each QCR and summarized by plan month and Benefit Option to calculate the Threshold Reduction and Limit Reduction.
  • Has applied the correct Cost Threshold and Cost Limit based upon the Plan Year End Date.
  • Has been accurately adjusted to account for coordination of individual retiree cost data should an individual beneficiary be covered under more than one Benefit Option or Subsidy Period, and/or have cost data reported by more than one source.
  • Does not include cost data for drugs that are not eligible for Medicare Part D.
  • Has accurately completed all financial accounting for beneficiary costs and Actual Cost Adjustments (for example, discounts, chargebacks, rebates, and similar price concessions) for this application.

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Status of the Last Report

The Benefit Option Cost Reporting Source List table displays "Status of Last Final Cost 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.

Step 1: Status Of Last Final Cost Report

When Reconciliation is initiated in Step 1: Initiate Reconciliation the “Status of Last Final Cost Report” reflects one of the following statuses:

  • No Reports
  • No Final Reports
  • Data Entry: Update/Entry Required

If a Mainframe Cost Report is received after Reconciliation is initiated in Step 1 and before final cost reporting is opened, the “Status of the Last Final Cost Report” is "Mainframe: Errors Detected."

Steps 5 and 6: Status Of Last Final Cost Report

During final cost reporting, the status of the last cost report reflects one of the following statuses:

  • No Reports
  • No Final Reports
  • Mainframe: Errors Detected
  • Mainframe: Submitted
  • Data Entry: Update/Entry Required
  • Data Entry: Saved
  • Data Entry: Submitted

Step 7: Status Of Last Final Cost Report

After final cost reporting is closed, and Step 6: Manage Submission of Final Cost Reports is complete, the Account Manager or Designee with 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 "Mainframe: Submitted" in Step 6 are reviewed in Step 7: Review Final Costs and may be included in the final Reconciliation payment request. Reviewing costs in Step 7 will change the “Status of Last Final Cost Report” in Step 6.

If the “Status of Last report” in Step 6 is "Mainframe: Errors Detected," previously accepted final costs may be eligible for review in Step 7. 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 Step 7 and may be included in the final Reconciliation payment request.

The following cost reporting review statuses result from the actions taken in Step 7:

  • Reviewed: Reject
  • Reviewed: Undo Reject
  • Review Complete: Accepted
  • Review Complete: Rejected

Note: If a Mainframe final cost report is submitted after Step 7 is closed, the “Status of Last Final Cost Report” appears as "Mainframe: Error Detected." If a final cost report was previously submitted without errors, the review status appears in the Audit Trail.

Step 12: Status Of Last Report

Completing Step 12: Review and Submit Reconciliation Payment Request changes the “Status of Last Final Cost Report” of all cost reports accepted in Step 7 to "Included in Final Payment Request" if the status is not "Mainframe: Errors Detected."

Reporting Statuses

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. All Plan Months 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.
Mainframe: Submitted This status pertains only to cost reports received using Mainframe 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.
Mainframe: Errors Detected This status pertains only to cost reports received using Mainframe 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 yet to be processed (Mainframe) or saved/submitted (Data Entry) for the Benefit Option by the reporting source.
No Final Reports This status pertains only to cost reports received using Mainframe 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 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 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 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 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 Step 12.

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What Happens After Step 6: Manage Submission of Final Cost Reports Is Complete

After Step 6: Manage Submission of Final Cost Reports is complete, the status of Step 6 changes to "Complete" and the Last Updated Date and Last Updated By fields are updated accordingly. Step 6 is marked with a green check 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. Step 7: Review Final Costs is marked with a blue arrow to indicate that it is the next step. Mainframe final cost reports that are submitted will now be rejected and appear in the Cost Reporting Audit Trail with a status of "Mainframe: Errors Detected." The status of the application changes to "Reconciliation Cost Reporting Closed."

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Step-by-Step Instructions

This section provides step-by-step instructions to complete the following tasks in Step 6: Manage Submission of Final Cost Reports:

View Cost Summary in Step 6: Manage Submission of Final Cost Reports

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 6: Manage Submission of Final Cost Reports.

     Select [Manage Submission of Final Cost Report]

On the Step 6: Manage Submission of Final Costs Reports page:

  1. Select View Cost Summary in the Actions column of the Benefit Option Cost Reporting Sources List table and select Go.

     Select [View Cost Summary], Select [Go]

On the Benefit Option Final Cost Summary page:

  1. Review the most recent final costs reported for each month of the plan year then select Return to Manage Submission of Final Cost Reports.

     Select [Return to Manage Submission of Final Cost Reports]

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Enter or Update Costs In Step 6: Manage Submission of Final Cost Reports

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 6: Manage Submission of Final Cost Reports.

     Select [Manage Submission of Final Cost Reports]

  On the Step 6: Manage Submission of Final Costs Reports page:

  1. Select 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 Cost privilege for a particular Benefit Option may modify cost amounts.

     Select [Enter/Update Costs], Select [Go]

On the Benefit Option Final Cost Data Entry View page:

  1. Select the edit link from the Benefit Option Final Cost Report table to enter or modify a particular Benefit Option month/year.

     Select [edit]

On the Benefit Option Cost Data Entry Edit page:

An asterisk (*) represents a required field.

  1. Enter the modified amount(s) in the following fields:
    • * Gross Retiree Cost
    • * Threshold Reduction
    • * Limit Reduction
    • * Actual Cost Adjustment
  2. Select Save to store the information and proceed or select Cancel to disregard any entry and return to the Benefit Option Final Cost Data Entry View page.

     Select [Save]

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View Audit Trail in Step 6: Manage Submission of Final Cost Reports

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 6: Manage Submission of Final Cost Reports.

     Select [Manage Submission of Final Cost Reports]

On the Step 6: Manage Submission of Final Costs Reports page:

  1. Select View Audit Trail in the Actions column of the Benefit Option Cost Reporting Sources List table and select Go.

     Select [View Audit Trail], Select [Go]

On the Audit Trail of Benefit Option Cost Reports page:

  1. Select View Cost Reports in the Actions column of the Audit Trail of Benefit Option Cost Reports table and select Go or select Return to Manage Submission of Final Cost Reports to return to the Step 6: Manage Submission of Final Cost Reports page.

     Select [View Cost Reports], Select [Go]

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Complete Step 6: Manage Submission of Final Cost Reports

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 6: Manage Submission of Final Cost Reports.

     Select [Manage Submission of Final Cost Reports]

On the Step 6: Manage Submission of Final Costs Reports page:

  1. Select Complete Reporting to complete Step 6 and close final cost reporting.

     Select [Complete Reporting]

On the Step 6: Manage Submission of Final Cost Reports Complete Verification page:

  1. Select Confirm to close final cost reporting or select Cancel to return to Step 6: Manage Submission of Final Cost Reports page without completing this step.

     Select [Confirm]

On the Step 6: Manage Submission of Final Cost Reports Complete Confirmation page:

  1. Select Continue to return to the Reconciliation Checklist page.

     Select [Continue]

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Reopen Step 6: Manage Submission of Final Cost Reports

To access the RDS Secure Website and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 6: Manage Submission of Final Cost Reports.

     Select [Manage Submission of Final Cost Reports]

On the Step 6: Manage Submission of Final Cost Reports page:

  1. Select Allow Reporting to reset Step 6 to "Incomplete" and once again allow final cost reporting.

     Select [Allow Reporting]

On the Step 6: Manage Submission of Final Cost Reports Allow Verification page:

  1. Select Confirm to reopen final cost reporting or select Cancel to return to Step 6: Manage Submission of Final Cost Reports page without modifying this step.

     Select [Confirm]

On the Step 6: Manage Submission of Final Cost Reports Allow Confirmation page:

  1. Select Continue to return to the Reconciliation Checklist page.

     Select [Continue]

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