Transcript Slide 1

August Manufacturer Webinar
Art Spaziano, Manager
Palmetto GBA
Medicare Part D, CGDP TPA
Agenda
• New Negative Amount Resolution Process
• Overview of the EFT distribution process
• Increase in incorrect payments to Sponsors
• Overview of the new Online Payment
Confirmation application
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New Negative Amount Resolution Process
Art Spaziano, Manager
Palmetto GBA
Medicare Part D, CGDP TPA
Current Status and Plan
• Manufacturer EFT data now being collected
– All input needed by August 17th
• Complete EFT records to be distributed to
Sponsors on August 25th
• Negative invoices distributed on October
17th
• Payments due 38 days later
• Annual cycle begins in April of 2014
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What’s Covered and Not Covered
• Covered:
– Negative balances due to deleted or adjusted
PDEs
– Cumulative amounts as of Q2 2013
• Not Covered:
– Amounts overpaid by Drug Manufacturers and
held by Sponsors
• Repayment must occur via an independent process
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Overview of the EFT Distribution Process
Lytarsha Jiles, Business Analyst
Palmetto GBA
Medicare Part D, CGDP TPA
Sponsor EFT Information
• No Dependency on APPS
• Opportunity to update each quarter
• Reminders will be sent prior to each update
deadline
• No update needed if there are no changes
• Full set of EFT records redistributed each
quarter
• Important for Manufacturers to download this file
each quarter
• Granular description of changes issued with each
update
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Manufacturer EFT Information
• Initial collection of data in process
• 100% participation is needed
• Initial file will be distributed on August 25th
• Opportunity to update each year
• Reminders will be sent prior to each update deadline
• No update needed if there are no changes
• Full set of EFT records redistributed each year
• Important for Sponsors to download this file each
quarter
• Granular description of changes issued with each
update
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Incorrect Payments to Sponsors
Anna Loveday, EDI Operations
Associate
Palmetto GBA
Medicare Part D, CGDP TPA
Various Payment Issues on the Increase
• Paying wrong amounts
• Should be using field 11 from the TPACT record of the
Invoice
• Paying wrong sponsors
• Internal payment processes need to be more carefully
managed
• Manufacturers should always download the latest EFT file
• Sponsors unsure how to allocate payments
• EFT IDs should always accompany payment
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Manufacturer Online Payment Confirmation
Overview
Diane Kreitz, Programmer /
Analyst
Palmetto GBA
Medicare Part D, CGDP TPA
Description and Capabilities
• A Web based tool for creating, editing and
submitting payment confirmations
• No need to edit flat files and submit via SFTP
• Readable invoices
• Also provides a list of payments to be made, including EFT ID
• Accessible via a new, secure Manufacturer’s
Portal
• Manufacturers can choose to stay with flat
files or switch to this new tool
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Logging In
13
Menu Choices
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Invoice List
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EZ Payment List
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Invoice List
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Main Screen
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Entering Amounts Paid
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Confirming Payments
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Transmitting Confirmation
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Transmission Receipt
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Status of Confirmations
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Next Steps
• Portal credentials to be distributed this
month
• Portal and application to be available later
this month
• Will be announced via ListServ
• Q2 2013 invoices will be accessible from the
portal when they are distributed to mail boxes
on August 31st
• Q2 2013 confirmations can be submitted any
time thereafter
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TPA Contact Information
Art Spaziano, Manager
Palmetto GBA
Medicare Part D, CGDP TPA
Contacting the TPA
• TPA website - http://tpadministrator.com
• Phone
– Help Line: 1-877-534-2772 – Option 1
– Hours: Monday thru Friday 8am to 7pm ET
• General email inquiries regarding the invoicing and payment process
should be sent to [email protected]
• Webinar slides will be posted to the TPA website
• Suggestions for future webinar topics should be sent to
[email protected]
• Questions related to dispute files, EFT information, invoice
corrections http://tpadministrator.com – Website
• [email protected] - Dispute support documentation
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Resources
• Medicare Drug Benefit Group
• Questions related to the Manufacturers Agreement, changes of ownership,
terminations, compliance / administrative-related issues, policy
• Email address is [email protected]
• Discount Program Manufacturer’s Page
• http://www.cms.gov/Medicare/Prescription-DrugCoverage/PrescriptionDrugCovGenIn/index.html?redirect=/PrescriptionDrugCov
GenIn/
• HPMS Website
Updating CMS contact and labeler code changes
• https://gateway.cms.gov - Website
• [email protected] - Password Resets
• [email protected] - Non-password access assistance
• Independent Review Entity (IRE) for Discount Program appeals.
• https://cgdpappeals.provider-resources.com/Default.aspx - Website