Conditions and Results for Completing Reconciliation Steps

Reconciliation Step

Conditions and Results For Completing Reconciliation Steps

Can The Step Be Reopened After Completed?

Initiate Reconciliation

• This step can be started after the plan year has ended and 16 days have elapsed from the last payment determination (no payment is in progress).
• After Reconciliation is initiated, the application status changes to "Reconciliation Initiated."
• After Reconciliation is initiated, RDS Secure Website users cannot report interim costs or request interim payments. Previously reported interim cost data will display in the audit trail accessible through Reconciliation: Manage Final Costs.
• After Reconciliation is initiated the status of a Data Entry cost report changes to "Data Entry: Update/Entry Required" in preparation for final cost reporting.
• After Reconciliation is initiated it cannot be reversed.

No

Finalize Covered Retirees

• This step can be started after initiating Reconciliation.
• A Covered Retiree List can be requested in this step until it is marked "Complete" with a green checkmark in the Left Navigation menu of the application.
• After this step is marked "Complete" the application status changes to "Reconciliation Cost Reporting Opened."
• After this step is marked "Complete" the Plan Sponsor is unable to upload Retiree files. Retiree files are rejected for the application and response files are sent with Reason Code 28: File Rejected - Closed Application, indicating the rejection. After this step is marked "Complete" the application status changes to "Reconciliation Cost Reporting Opened."
• After this step is marked "Complete" CMS' RDS Center no longer creates or sends Weekly Notification Files.
• After this step is marked "Complete" Medicare Part D Enrollment Rejection Notifications are no longer posted to the RDS Secure Website.
• After this step is marked "Complete" an email is sent to the Authorized Representative, Account Manager, and Designee with the View/Send/Receive Retiree Data privilege informing them that retiree processing has stopped.
• To reopen this step, the Authorized Representative or Account Manager can Reset Reconciliation on the Reconciliation: Finalize Covered Retirees page prior to completion of Reconciliation: Review and Submit. If the reset request is submitted timely, Reconciliation: Finalize Covered Retirees is changed to an "Incomplete" status after completion and ALL subsequent Reconciliation steps that were previously completed—beginning with Reconciliation: Finalize Covered Retirees—are changed to an "Incomplete" status and must be completed again. The application's Reconciliation Deadline will not change.

Yes – Select Reset Reconciliation on the Reconciliation: Finalize Covered Retirees page prior to completion of Reconciliation: Review and Submit

Manage Final Costs

• This step can be started after all previous Reconciliation steps are marked "Complete" with a green checkmark in the Left Navigation menu of the application.
• After this step is marked "Complete" the application status changes to "Reconciliation Cost Reporting Closed."
• After this step is marked "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."
• After this step is marked "Complete" the Plan Sponsor can reopen and recomplete Reconciliation: Manage Final Costs as many times as necessary until completing Reconciliation: Review and Submit or the Reconciliation Deadline is past.
• The Plan Sponsor can reopen this step by selecting Allow Reporting in Reconciliation: Manage Final Costs. If Allow Reporting is selected, CMS' RDS Center will accept final cost reports submitted by Connect:Direct and allow data entry cost reporting on the RDS Secure Website.
• If Allow Reporting is selected in this step, all subsequent Reconciliation steps are marked "Incomplete" and the application status changes to "Reconciliation Cost Reporting Opened."

Yes – Select Allow Reporting in Reconciliation: Manage Final Costs

Or

Recompleting a previous Reconciliation step will change this step to "Incomplete."

Review Final Costs

• This step can be started after all previous Reconciliation steps are marked "Complete" with a green checkmark in the Left Navigation menu of the application.
• After this step is marked "Complete" the status of the application remains "Reconciliation Cost Reporting Closed."
• After this step is marked "Complete" the status of individual cost reports in Reconciliation: Manage Final Costs changes to reflect the result of the review. The review status indicates that Reconciliation: Review Final Costs is complete and whether or not the cost report was accepted or rejected.
• After this step is marked "Complete" the Plan Sponsor can reopen and recomplete Reconciliation: Manage Final Costs as many times as necessary until completing Reconciliation: Review and Submit or the Reconciliation Deadline is past.
• The Plan Sponsor can reopen this step by selecting Open Review in Reconciliation: Review Final Costs or Allow Reporting in Reconciliation: Manage Final Costs.
• If Allow Reporting is selected in Reconciliation: Manage Final Costs, all subsequent Reconciliation steps are marked "Incomplete" and the application status changes to "Reconciliation Cost Reporting Opened."
• After this step is marked "Complete" rejecting the Subsidy Amount in Reconciliation: Review and Submit will change this step to "Incomplete" (Authorized Representative only).

Yes – Select Open Review in Reconciliation: Review Final Costs

Or

Select Allow Reporting in Reconciliation: Manage Final Costs

Or

Recompleting a previous Reconciliation step will change this step to "Incomplete."

Review Final Payment Request

• This step can be started after all previous Reconciliation steps are marked "Complete" with a green checkmark in the Left Navigation menu of the application.
• After this step is marked "Complete" recompleting a previous Reconciliation step will change this step to "Incomplete."

Yes - Reject Subsidy Amount in Reconciliation: Review and Submit (Authorized Representative only)

Or

Recompleting a previous Reconciliation step will change this step to "Incomplete."

Banking Information

• This step can be started after all previous Reconciliation steps are marked "Complete" with a green checkmark in the Left Navigation menu of the application.
• This step can be revisited as many times as necessary until the Plan Sponsor completes Reconciliation: Review and Submit or the Reconciliation Deadline is past.
• After this step is marked "Complete" a notification email is automatically sent to the Authorized Representative.
• After this step is marked "Complete" changing Banking Information will change this step to "Incomplete."
• After this step is marked "Complete" a pre-note failure will change this step to "Incomplete."
• After this step is marked "Complete" recompleting a previous Reconciliation step will change this step to "Incomplete."
• After this step is marked "Complete" rejecting the Banking Information or Subsidy Amount in Reconciliation: Review and Submit will change this step to "Incomplete" (Authorized Representative only).

Yes – Enter new Banking Information

Or

Rejecting Banking Information in Reconciliation: Review and Submit (Authorized Representative only)

Or

Rejecting Subsidy Amount in Reconciliation: Review and Submit (Authorized Representative only)

Or

Recompleting a previous Reconciliation step will change this step to "Incomplete."

Review and Submit

• This step can be started after all previous Reconciliation steps have been marked "Complete."
• After this step is marked "Complete" it cannot be reversed.
• After this step is marked "Complete," on the Dashboard page, the application will be removed from the In Progress view and will display in the Completed view.
• If the Authorized Representative rejects the Reconciliation payment request for incorrect banking information, Reconciliation: Banking Information will be marked "Incomplete" and must be recompleted with any necessary changes.
• If the Authorized Representative rejects the Reconciliation payment request for incorrect subsidy amount, Reconciliation: Banking Information and Reconciliation: Review Final Payment Request will be marked "Incomplete" and must be recompleted with any necessary changes.
• After this step is marked "Complete," if the ACH-EFT payment transaction is rejected by the Plan Sponsor’s bank, Reconciliation: Banking Information and Reconciliation: Review and Submit will be marked "Incomplete" and must be recompleted.

No