User Roles Support Tool: Reconciliation

User Roles:

AM

AR

D

Program Components:

Reconciliation

Reconciliation is the process where, after the end of the plan year, the Plan Sponsor finalizes the Covered Retiree List and submits all final cost data. The following identifies the actions and user roles associated with Reconciliation, including the 12 steps of the Reconciliation Process.

Beginning Reconciliation AM AR

The Beginning Reconciliation phase consists of Step 1: Initiate Reconciliation and Step 2: Review Payment Setup.

Only the Account Manager or Authorized Representative may complete Step 1: Initiate Reconciliation. Designees with Request Payment privilege may view this step but not initiate it.

Only the Account Manager or Authorized Representative may complete Step 2: Review Payment Setup. Designees with Request Payment privilege may view this step but not initiate it.

Finalizing Retirees AM AR D

The Finalizing Retirees phase consists of Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees. During this phase, Plan Sponsors and Vendors complete the Retiree Data Exchange.

The Account Manager, Authorized Representative, or Designee with both the Request Payment and View/Send/Receive Retiree Data privileges may complete Step 3: Request List of Covered Retirees.

Only the Account Manager or Authorized Representative may complete Step 4: Finalize Covered Retirees. Designees with Request Payment privilege may view this step but cannot complete it.

Federal law requires that the Plan Sponsor submit cost data only for the Qualifying Covered Retirees (QCR), corresponding Subsidy Periods, and the Benefit Option in which the QCR is enrolled. By completing the Finalize Covered Retirees step, the Plan Sponsor is agreeing to the accuracy of the Covered Retiree List. When the Covered Retiree List is finalized, CMS' RDS Center stops all retiree processing for that application.

Finalizing Costs AM D

The Finalizing Costs phase consists of Step 5: Start Preparation of Reconciliation Payment Request, Step 6: Manage Submission of Final Cost Reports, Step 7: Review Final Costs, and Step 8: Enter Revisions to Final Costs. During this phase, Plan Sponsors and Vendors complete final cost reporting.

Only the Account Manager or Designee with Request Payment privilege may complete Step 5: Start Preparation of Reconciliation Payment Request. The Authorized Representative has “View Only” access to this page.

Only the Account Manager or Designee with Request Payment privilege may close or re-open final cost reporting in Step 6: Manage Submission of Final Cost Reports. If the Account Manager has the Report Costs privilege for the application, they may enter final cost reports for any Benefit Options they were assigned in Payment Setup.

Designee Cost Reporters do not have access to the Reconciliation Checklist and Step 6: Manage Submission of Final Cost Reports. 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: Manage Submission of Final Cost Reports.

The Account Manager, Authorized Representative, and Designee with Request Payment privilege may access Step 6: Manage Submission of Final Cost Reports 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.

Only the Account Manager or Designee with Request Payment privilege may complete Step 7: Review Final Costs. The Authorized Representative has "View Only" access to this step.

Only the Account Manager or Designee with Request Payment privilege may complete Step 8: Enter Revisions to Final Costs. The Authorized Representative has "View Only" access to this step.

Providing Payment Information AM AR D

The Providing Payment Information phase consists of Step 9: Finalize Reconciliation Payment Request and Step 10: Review Electronic Funds Transfer (EFT) Information.

The Account Manager or Designee with Request Payment privilege may complete Step 9: Finalize Reconciliation Payment Request. The Authorized Representative has "View Only" access to this step. Multiple users are involved in cost reporting and preparing the Reconciliation payment request, so it is important for the Plan Sponsor to carefully coordinate the completion of this step.

The Account Manager, Authorized Representative, or Designee with both the Complete Electronic Funds Transfer (EFT) Information and Request Payment privileges may complete Step 10: Review Electronic Funds Transfer (EFT) Information.

Approving and Submitting the Reconciliation Payment Request AR

Approving and Submitting the Reconciliation Payment Request is the final phase of Reconciliation. This phase consists of Step 11: Approve Electronic Funds Transfer (EFT) Information and Step 12: Review and Submit Reconciliation Payment Request.

Only the Authorized Representative may complete Step 11: Approve Electronic Funds Transfer (EFT) Information. The Account Manager and Designees with both the Complete Electronic Funds Transfer (EFT) Information and Request Payment privileges have "View Only" access to this step.

Only the Authorized Representative may complete Step 12: Review and Submit Reconciliation Payment Request. The Account Manager or Designee with the Request Payment privilege have "View Only" access to this step. Rejecting the Reconciliation payment request will require Steps 9 through 11 to be completed again with any necessary changes by the Account Manager, Designees with the Request Payment privilege, and Cost Reporters.