Submit an Interim Payment Request

User Roles:

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Program Components:

Interim Payment

Overview

This section provides an overview of the following topics related to submitting an interim payment request to CMS' RDS Center.

Introduction to Submitting an Interim Payment Request

Plan Sponsors may choose an Interim Payment Frequency during the Application Submission Process. Instead of receiving a one-time final payment after completing Reconciliation, Plan Sponsors may receive interim payments throughout the application's plan year. A Plan Sponsor often repeats the interim payment process several times throughout the lifecycle of the application.

During the interim payment process, the Payment Requester reviews Benefit Option costs submitted by Cost Reporter(s); builds the payment request by selecting which Benefit Options to include; and submits the payment request to CMS' RDS Center.

An interim payment request may include any updated costs submitted for a Benefit Option. Before the updated Benefit Option costs can be included in the payment request, the Payment Requester must first review all of the Benefit Option costs. For more information about how Payment Requesters review interim costs submitted for a Benefit Option, refer to Complete Review of Benefit Option Interim Costs.

When at least one Benefit Option is eligible to be included in a payment request, the Payment Requester may build an interim payment request by reviewing the costs, selecting which Benefit Options to include, and submitting the request to CMS' RDS Center. For more information on how to build and submit an interim payment request, refer to Build and Submit an Interim Payment Request.

Resources:

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Timing for Submitting an Interim Payment Request

An interim payment may be requested on an application when the following conditions are met:

  • The application is approved.
  • Payment Setup is complete.
  • The application has an Interim Payment Frequency and the maximum number of payment requests has not been met:
    • Monthly - The Monthly Payment Frequency allows Plan Sponsors to make a maximum of twelve (12) interim payment requests for a plan year. The first payment request can be submitted after one month from the start of the plan year once interim costs are reported. Although twelve (12) interim payments are allowed, a Plan Sponsor may choose to submit fewer than twelve.
    • Quarterly - The Quarterly Payment Frequency allows Plan Sponsors to make a maximum of four (4) interim payment requests for a plan year. The first payment request can be submitted after one quarter since the start of the plan year once interim costs are reported. Although four (4) interim payment requests are allowed, a Plan Sponsor may choose to submit fewer than four.
    • Interim Annual - The Interim Annual Payment Frequency allows Plan Sponsors to make a maximum of one (1) interim payment request for a plan year. The interim annual payment request cannot be made until one day after the Plan Year End Date.
  • New interim costs were submitted for at least one Benefit Option since the last payment request and the Payment Requester completed the review for the new interim costs.
  • At least 16 days have passed since the last payment approval or 31 days have passed since the last payment request; whichever is later.
  • To request another interim payment, the Next Payment Request status displays "Payment Can Now Be Requested." If a payment request is in progress, the Plan Sponsor cannot request payment.

Note: Applications with an Annual Payment Frequency are not eligible for interim payment.

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User Roles and Responsibilities for Submitting an Interim Payment Request

Payment Requester

A Payment Requester is an individual that has been granted permission and is assigned to build and submit payment requests using the RDS Secure Website. Payment Requesters can be assigned to an application during the Payment Setup process. The Request Payment privilege is automatically assigned to the Authorized Representative, but can also be assigned to the Account Manager or a Designee by assigning them the Request Payment privilege. An application may have one or more Payment Requesters assigned simultaneously. A Payment Requester views Benefit Option costs through the Request Payment action and not through the same pages as a Cost Reporter.

Payment Setup must be complete before payments can be requested. For more information about Payment Setup, refer to Complete Payment Setup.

RDS User Roles and System Access for the Request Payment Privilege

Authorized Representative

Since the Authorized Representative is the only individual who may submit the annual payment request or Reconciliation payment request, they are automatically granted the Request Payment privilege during Payment Setup. The Authorized Representative always has the ability to review cost reports, build and submit payment requests, and view payment request statuses and payment history. Therefore, the Authorized Representative does not have the ability to report costs.

Account Manager

During Payment Setup, the Account Manager must be assigned one of three privileges: Request Payment privilege, Report Costs privilege, or View Only privilege. The Account Manager may not have both the Report Costs privilege and the Request Payment privilege on the same application. A Payment Requester cannot report costs, and a Cost Reporter cannot request payments.

An Account Manager with the Request Payment privilege is able to review cost reports, build and submit payment requests, and view payment request statuses and payment history. If the Account Manager is assigned the Report Costs privilege or View Only privilege, they are only able to view payment data such as the status of current Benefit Option costs and payment requests.

Designees

The Designee can be assigned the Request Payment privilege or the Report Costs privilege in Payment Setup, but not both in the same application. Designees with the Request Payment privilege are able to review cost reports, build and submit payment requests, and view payment request statuses and payment history. Designees assigned the Report Costs privilege do not have payment request access for the application.

Note: The Account Manager and Authorized Representative must maintain active RDS Secure Website user accounts in order for a Plan Sponsor to receive payment. Accounts can be disabled due to inactivity or inactivated due to an invalid email address. It is important for the Account Manager and Authorized Representative to verify their email address prior to payment. If a user account becomes inactive or disabled while payment is in progress, the payment will be halted.

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Preparing for an Interim Payment Request

During the Interim Payment process, the Payment Requester reviews Benefit Option costs submitted by Cost Reporter(s); builds the payment request by selecting which Benefit Options to include; and submits the payment request to CMS' RDS Center.

An interim payment request may include any updated Benefit Option costs that have been submitted for a Benefit Option by a Cost Reporter. Only submitted cost reports can be reviewed by a Payment Requester, and only reviewed Benefit Option costs can be included in an interim payment request.

Note: A cost report is not considered to be submitted or in "Submitted" status if it is only saved through Data Entry method or is submitted with errors through the Mainframe method.

The Build Interim Payment Request Page

Authorized Representatives, Account Managers, and Designees with the Request Payment privilege may review Benefit Option costs or build a payment request using the Build Interim Payment Request page on the RDS Secure Website.

The Benefit Options Cost Summary table displays interim costs reported for each Benefit Option in the application. From this table you can review the Benefit Option costs, view the Report Reviewed status for each of the Benefit Option costs, and select a Benefit Option to include in a payment request.

The following payment and cost reporting information for each Benefit Option is available on this page:

  • Report Reviewed – Displays a status of "Costs Reviewed", "Costs Not Reviewed", or "No New Costs to Review" for the Payment Requester to review the most recently submitted Benefit Option costs.
  • Payment Request Last Submitted – Displays a status of "No Request" or the date the Benefit Option was last included in a payment request.
  • Cost Report Last Submitted – Displays a status of "No Reports" or the date of the last submitted cost report.
  • Current Subsidy Amount – Displays the calculated subsidy amount derived from the most recent interim cost reports submitted for the Benefit Option.
  • Old Subsidy Amount – Displays the calculated subsidy amount derived from the interim costs reported for the Benefit Option that were last included in a payment request that was not cancelled.
  • Net Subsidy Amount – Displays the calculated difference between the Current Subsidy Amount and the Old Subsidy Amount. The Net Subsidy Amount for the Benefit Option is the amount of subsidy eligible to be included in a payment request. The amount of the payment request equals the sum of the Net Subsidy amounts for all Benefit Options included in the payment request.
  • Number of Reporting Sources – Displays the number of Cost Reporting Sources (Plan Sponsor and/or Vendors) eligible to report costs for the Benefit Option.

    Screen shot of Build Interim Payment Request page.

Reviewing Interim Costs by Benefit Option

Benefit Option costs must be reviewed before the Benefit Option can be included in a payment request. The Payment Requester must review the Benefit Option costs to ensure the costs are accurate, are complete, and are not duplicated. The Payment Requester may only view costs that are submitted by Data Entry and/or by Mainframe transmission. Data Entry costs saved on the RDS Secure Website cannot be viewed by a Payment Requester until submitted by the Cost Reporter. Mainframe costs with detected errors cannot be viewed by the Payment Requester. When the Benefit Option has a status of "Costs Reviewed" and there are no errors detected at the Benefit Option level, it is eligible to be included in an interim payment request.

If errors are detected on submitted costs, the Payment Requester cannot change cost data. Only Cost Reporters may change or submit cost data. Errors are typically due to a change in Qualifying Covered Retiree (QCR) information, since costs were last submitted for the Benefit Option. It is possible that the maximum Allowable Retiree Costs or maximum Threshold Reduction amount reported exceeds the QCR information associated with the Benefit Option. The Payment Requester must coordinate with the Cost Reporter(s) to determine if costs or QCR information must be updated for the Benefit Option.

Note: A Cost Reporter may continue to transfer Mainframe files or report interim costs using the RDS Secure Website regardless of whether previously reported costs have been included in a payment request. All submitted costs are maintained and can be included in the next payment request.

The Benefit Option Interim Costs Review Page

All reported costs and the calculated subsidy for the Benefit Option are displayed on the Benefit Option Interim Costs Review page for the Payment Requester to review. Benefit Option costs may be reviewed by plan month and also at the Cost Reporting Source level. Three tables display on this page:

  • The Benefit Option Interim Cost Reporting Sources List table displays the date of the last payment request, the date of the last submitted cost report and the Current Allowable Retiree Costs for each Cost Reporting Source for the selected Benefit Option.
  • The Plan Year Benefit Option Cost Summary table displays the Current, Old, and Net interim cost data for the selected Benefit Option for the entire plan year.
  • The Monthly Benefit Option Cost Summary table displays the Current, Old, and Net interim cost data for the selected Benefit Option by plan month.

Notes:

  • Current costs reflect the most recently submitted costs for the Benefit Option.
  • Old costs reflect the submitted costs last included in a payment request.
  • Net costs are calculated as the difference between "Current" and "Old" costs. The Net Subsidy Amount is the amount eligible for payment when the Benefit Option is included in a payment request.
  • The Complete Review button does not display for Account Managers with View Only or Report Costs privilege.

    Screen shot of Benefit Option Interim Costs Review page.

Building and Submitting an Interim Payment Request

When at least one Benefit Option is eligible to be included in a payment request, the Payment Requester may build an interim payment request by selecting which Benefit Options to include on the Build Interim Payment Request page. The Benefit Option costs include the system-calculated subsidy amounts based on the submitted cost data. The Plan Sponsor may decide to include all or a portion of the eligible Benefit Options in the interim payment request. A Benefit Option is eligible to be included in a payment request when the following conditions are met:

  • New interim costs were submitted for the Benefit Option since the last payment request;
  • The Benefit Option has a "Costs Reviewed" status in the Benefit Option Cost Summary table; and
  • No system errors have been detected for the submitted Benefit Option costs.

Note: Benefit Option costs must be reviewed by the Payment Requester to be eligible to be included in a payment request. For more information, refer to Complete Review of Benefit Option Interim Costs.

The Payment Requester may review the interim payment request aggregated costs after continuing with the build an interim payment request process on the Interim Payment Request Verification page. This page displays the total costs and subsidy amounts requested for all Benefit Options included in the payment request, broken down by Benefit Option and total requested by plan month/year.

As the Payment Requester proceeds with the payment request, the RDS Secure Website examines the costs for the entire application and each Benefit Option included in the payment request. If errors are detected during the Payment Verification stage, the Payment Requester may not proceed with the payment request. Only Cost Reporter(s) may change or update costs. The Payment Requester must contact the Cost Reporter(s) to address the detected errors and resubmit costs. To proceed with the interim payment request, the Payment Requester may return to the Build Interim Payment Request page and exclude the Benefit Option(s) with detected errors from the request.

For more information on correcting cost reporting errors, refer to Error Conditions.

If no errors are detected at the Payment Verification stage, the Payment Requester submits the payment request by authorizing the payment request. The Payment Requester is required to answer a series of authentication security questions on the Interim Payment Request Authorization page. After submitting the interim payment request, the Interim Payment Request Confirmation page displays and includes the total amount of the subsidy request, the current date, and the breakdown of Benefit Options included in the payment request.

Requested payments are usually processed within 30 calendar days from the date the request is submitted. An email is sent to notify the Plan Sponsor after a payment has been approved. The email is sent to the Account Manager and the Authorized Representative is copied.

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Determining and Rendering Payment

After a payment request is made, CMS' RDS Center validates the payment request, makes payment adjustments to the request if necessary, sends the subsidy payment using Electronic Funds Transfer (EFT), and notifies the Plan Sponsor of the payment status.

Payment Request Statuses

The payment request status is reflected on the Build Interim Payment Request page, in the Status of Last Request field. The following statuses apply to a payment request:

  • Payment Requested: Request was made on the RDS Secure Website. This status indicates that a request has been submitted and payment is in progress.
  • Payment Processed: CMS' RDS Center has finalized the payment for this payment request. The Plan Sponsor receives an email providing the details about CMS' RDS Center payment approval.
  • Payment Pending due to EFT failure: The ACH-EFT payment transaction was rejected by the Plan Sponsor's bank. CMS' RDS Center uses the banking information (Account Number, Bank Routing Number, and Account Type) from the application. The Plan Sponsor receives an email to inform them a change of EFT Information is required. After a successful pre-note is obtained, CMS' RDS Center again attempts the subsidy payment. For more information on how to update EFT Information on a submitted application, refer to Manage Electronic Funds Transfer (EFT) Information.
  • Payment Request Cancelled/Rejected: CMS' RDS Center cancelled the payment request.
  • Payment Rejected due to Debarment: CMS' RDS Center must validate that entities and people are not prohibited from doing business with the government prior to making a subsidy payment. If the Plan Sponsor or any of the following people associated with the application (the Authorized Representative, the Account Manager, all Actuaries, and all Designees) are found on the U.S. General Services Administration (GSA) Debarment List or the Office of Inspector General (OIG) Exclusion List, the payment request is cancelled.

Note: For more information on payment history events including payment request statuses and other payment activities, refer to Access Payment History.

Payment Validation

During the Payment Validation process, there are several conditions that delay or stop payment:

  • Account Managers and Authorized Representatives with inactive or pending RDS Secure Website accounts delay or stop payment. It is critical that all system users keep their information up-to-date. The most common reason for a user to become inactive is due to an invalid email address. CMS' RDS Center periodically sends email notices. If an email repeatedly bounces back, the account can become flagged as inactive.
  • Reassigned Account Managers and Authorized Representatives that have not yet registered in the RDS Secure Website delay or stop payment.
  • Submitting an interim payment request 60 days from the Reconciliation Deadline delays or stops payment. Interim payments must be stopped prior to starting Reconciliation; otherwise, it results in a cancellation.

Payment Adjustments

Payment adjustments on positive payment requests are made to offset negative payment requests. A negative payment request occurs when the Plan Sponsor has a negative balance. If the Plan Sponsor has a negative balance or overpayment on an application, CMS' RDS Center deducts the negative amount from any positive interim payment requests or any positive final payment requests for the same Plan Sponsor.

If after any payment adjustments, the payment determination amount is still positive (meaning it is greater than zero), then subsidy payment is rendered. 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).

Notes:

Banking Information (EFT) Failure

EFT information must be maintained on the application for CMS' RDS Center to send subsidy payments to the Plan Sponsor's bank. The Plan Sponsor may change EFT information at their discretion or after CMS' RDS Center sends an email notification of payment or pre-note failure due to invalid or missing banking information.

CMS' RDS Center validates certain information including Account Type, Account Number, and Bank Routing Number. If CMS' RDS Center could not process a payment request, the application status is marked "Application Error" and the EFT section of the application is marked "Error-Needs Attention." The Plan Sponsor is notified by email, and the subsidy payment is held. For more information on changing EFT information on an application, refer to Manage Electronic Funds Transfer (EFT) Information. Once a successful pre-note is obtained, CMS' RDS Center again attempts the subsidy payment.

Note: For more information on payment history including the status of EFT information as part of payment processing, refer to Access Payment History.

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Error Conditions

The Payment Requester may come upon system errors when completing review of Benefit Option costs or when building a payment request during the payment verification stage. The RDS Secure Website prevents the Payment Requester from proceeding with the payment request if system errors are detected.

The RDS Secure Website applies cost edits to the total costs accepted for the application by examining costs and Qualifying Covered Retirees (QCRs) for the entire application and each Benefit Option included in the payment request. These edits assure that the maximum Allowable Retiree Cost and Threshold Reduction have not been exceeded per individual QCR as a result of insufficient coordination of individual retiree costs or a reduction in retirees since costs were last reported.

Note: The Plan Sponsor may choose to proceed with the interim payment request by excluding Benefit Options with detected errors.

Application Level Errors

For each error detected in the combined application costs, a detailed error message appears at the top of the Interim Payment Request Verification page. The Continue button is hidden. The Plan Sponsor may view the accepted costs for each Benefit Option in detail by selecting the "View Costs" from the Actions dropdown menu on the Benefit Options Included in Payment Request table.

Benefit Option Level Errors

When the Payment Requester reviews Benefit Options Costs, any system errors detected are displayed at the top of the Benefit Option Interim Costs Review page. An error message displays for each error detected in Benefit Option costs. The RDS Secure Website prevents the Payment Requester from completing review of the Benefit Option costs if errors are detected. The Complete Review button is hidden.

Should one or more errors be detected in Benefit Option costs during payment verification, an error message appears in red at the top of the Interim Payment Request Verification page and an ! icon appears in the Errors column in the Benefit Options Included in Payment Request table for the appropriate Benefit Options. The Continue button is hidden. The Plan Sponsor must select "View Costs" from the Actions dropdown menu for the Benefit Option to view detailed error messages on the Benefit Option Interim Costs Review page.

Resolving Error Conditions

Errors may be due to a change in Qualifying Covered Retiree (QCR) information, since costs were last submitted. It is possible the maximum Allowable Retiree Costs or maximum Threshold Reduction amount reported exceeded the QCR information associated with the Benefit Option or application. Also, errors may be due to insufficient coordination of individual retiree costs between Cost Reporting Sources or across Benefit Options.

Only Cost Reporter(s) may change or update costs. The Payment Requester must coordinate with the Cost Reporter(s) to determine if costs must be updated based on new QCR information or the Covered Retiree List (CRL) must be updated with current coverage information.

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Step-by-Step Instructions

This section provides step-by-step instructions to complete the following tasks for submitting an interim payment request:

Complete Review of Benefit Option Interim Costs

Note: The Payment Requester is required to complete the cost review process before the Benefit Option can be included in a payment request. For more information on building and submitting a payment request, refer to Build and Submit an Interim Payment Request.

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

On the Application List page:

  1. Find the appropriate Application ID.
  2. Select Request Payment from the Actions dropdown menu from the Application List table and select Go.

Notes:

  • The Request Payment action only displays in the Actions column for Authorized Representatives, Account Managers, and Designees assigned the Request Payment privilege during Payment Setup. Cost Reporter Designees do not have access to this page.
  • The Request Payment action does not display unless the application status is "Approved," Payment Setup is complete, and the application Payment Frequency is Monthly, Quarterly, or Interim Annual.

    Screen shot of Application List page with emphasis on Request Payment action and  Go button.

On the Build Interim Payment Request page:

  1. Find the appropriate Benefit Option for which costs may be reviewed.
  2. Select Review Costs from the Actions dropdown from the Benefit Options Cost Summary table and select Go.

    Note: The Review Costs action only displays if interim costs are submitted for the Benefit Option.

    Screen shot of Build Interim Payment Request page with emphasis on Review Costs action and Go button.

On the Benefit Option Interim Costs Review page:

  1. Review the Benefit Option Costs for accuracy.
  2. Select Complete Review to complete your review or select Cancel to cancel your review and return to the Build Interim Payment Request page.

    Notes:

    • After you have completed the review for a Benefit Option by selecting Complete Review, you may review the costs again at any time by repeating steps 3 - 6. The only difference is Complete Review no longer displays. Select Continue to return to the Build Interim Payment Request page.
    • Complete Review does not display for Account Managers with View Only or Report Costs privilege, only Continue displays.

    Screen shot of Benefit Option Interim Costs Review page with emphasis on the Continue button.

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Build and Submit an Interim Payment Request

Note: To be eligible to be included in a payment request, Benefit Option interim costs must be reviewed and have a Review Status of "Costs Reviewed."

On the Application List page:

  1. Find the appropriate Application ID.
  2. Select Request Payment from the Actions dropdown menu from the Application List table and select Go.

    Notes:

    • The Request Payment action only displays in the Actions column for Authorized Representatives, Account Managers and Designees assigned the Request Payment privilege during Payment Setup. Cost Reporter Designees do not have access to this page.
    • The Request Payment action does not display unless the application status is "Approved," Payment Setup is complete, and the application Payment Frequency is Monthly, Quarterly, or Interim Annual.

    Screen shot of Application List page with emphasis on the Request Payment action and the Go button.

On the Build Interim Payment Request page:

  1. To include the interim costs for a Benefit Option in a payment request, select the Include In Payment Request checkbox.
  2. Select Continue.

    Note: The Include In Payment Request checkbox becomes enabled if the application is eligible for payment, interim costs were submitted since payment was last requested, and the Review Status is "Costs Reviewed" for the Benefit Option.

    Screen shot of Build Interim Payment page with emphasis on the Include in Payment Request checkbox and the Continue button.

On the Interim Payment Request Verification page:

  1. To not proceed with the payment request, select Cancel to return to the Build Interim Payment Request page.
  2. To proceed with the payment request, select Continue.

    Note: To view the most current costs associated with a Benefit Option from this page, select View Costs from the Actions dropdown menu from the Benefit Options Included in Payment Request table, next to the applicable Benefit Option.

    Screen shot of Interim Payment Request Verification page with emphasis on the Continue button.

On the Interim Payment Request Authorization page:

  1. To submit the payment request, select the checkbox confirming your agreement to the Interim Payment Request Authorization agreement, answer the two security questions, and select Submit; or, select Cancel to return to the Interim Payment Request Verification page without submitting the payment request.

    When submitting the payment request, allow the RDS Secure Website several minutes to provide confirmation that the request has been submitted. If a user does not wait for confirmation and submits a second payment request while another request is processing, the RDS Secure Website will display an error screen. Only one payment request at a time can be in process for an application.

    Note: The Interim Payment Request Authorization page displays the total amount of the subsidy request, the current date, the application Unique Retiree Count, the Payment Agreement, and the Payment Requester's security questions.

    Screen shot of Interim Payment Request Authorization page with emphasis on the Submit button.

On the Interim Payment Request Confirmation page:

  1. Select Continue to return to the Application List page.

    Note: Allow up to 30 days for the payment request to be processed. The Account Manager and Authorized Representative listed on the application are notified by email when the payment is finalized.

    Screen shot of Interim Payment Request Confirmation page with emphasis on the Continue button.

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