Download - August Manufacturer Webinar

August Manufacturer Webinar

Art Spaziano, ManagerPalmetto GBAMedicare Part D, CGDP TPA

• 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

AgendaAgenda

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New Negative Amount Resolution Process


• 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

Current Status and PlanCurrent Status and Plan

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• 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

What’s Covered and Not Covered

What’s Covered and Not Covered

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Overview of the EFT Distribution Process

Lytarsha Jiles, Business AnalystPalmetto GBAMedicare Part D, CGDP TPA

• 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

Sponsor EFT InformationSponsor EFT Information

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• 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

Manufacturer EFT InformationManufacturer EFT Information

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Incorrect Payments to Sponsors

Anna Loveday, EDI Operations AssociatePalmetto GBAMedicare Part D, CGDP TPA

• 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

Various Payment Issues on the Increase

Various Payment Issues on the Increase

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Manufacturer Online Payment Confirmation Overview

Diane Kreitz, Programmer / AnalystPalmetto GBAMedicare Part D, CGDP TPA

• 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

Description and CapabilitiesDescription and Capabilities

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Logging InLogging In

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Menu ChoicesMenu Choices

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Invoice ListInvoice List

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EZ Payment ListEZ Payment List

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Invoice ListInvoice List

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Main ScreenMain Screen

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Entering Amounts PaidEntering Amounts Paid

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Confirming PaymentsConfirming Payments

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Transmitting ConfirmationTransmitting Confirmation

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Transmission ReceiptTransmission Receipt

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Status of ConfirmationsStatus of Confirmations

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• 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

Next StepsNext Steps

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TPA Contact Information


Contacting the TPAContacting 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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http://tpadministrator.com/

mailto:[email protected]

ResourcesResources

•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-Drug-Coverage/

PrescriptionDrugCovGenIn/index.html?redirect=/PrescriptionDrugCovGenIn/

•HPMS WebsiteUpdating 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