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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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August Manufacturer Webinar

Art Spaziano, Manager

Palmetto GBA

Medicare Part D, CGDP TPA


Agenda
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


New Negative Amount Resolution Process

Art Spaziano, Manager

Palmetto GBA

Medicare Part D, CGDP TPA


Current status and plan
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


What s covered and not covered
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


Overview of the EFT Distribution Process

Lytarsha Jiles, Business Analyst

Palmetto GBA

Medicare Part D, CGDP TPA


Sponsor eft information
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


Manufacturer eft information
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


Incorrect Payments to Sponsors

Anna Loveday, EDI Operations Associate

Palmetto GBA

Medicare Part D, CGDP TPA


Various payment issues on the increase
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


Manufacturer Online Payment Confirmation

Overview

Diane Kreitz, Programmer / Analyst

Palmetto GBA

Medicare Part D, CGDP TPA


Description and capabilities
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













  • Next steps
    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


    TPA Contact Information

    Art Spaziano, Manager

    Palmetto GBA

    Medicare Part D, CGDP TPA


    Contacting the 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


    Resources
    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-Drug-Coverage/PrescriptionDrugCovGenIn/index.html?redirect=/PrescriptionDrugCovGenIn/

    • 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


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