Manufacturers Webinar

1. Manufacturers Webinar March 2, 2011

2. Agenda • Invoice Correction Process • Payment Confirmation Process • Frequently Asked Questions • Dispute Process • Questions and Answers

3. Announcements • Connectivity reminder from TPA • When sending emails to the TPA please include the P Number in the subject line of the email

4. Webinar Schedule • April 6th, 2011 4:00-5:00 p.m. ET • May 4th, 2011 4:00-5:00 p.m. ET • June 1st, 2011 4:00-5:00 p.m. ET • July 6th, 2011 4:00-5:00 p.m. ET

5. Accomplishments • Released EFT template • 2/8/2011 • Updated Manufacturer's Report layout • 2/23/2011 • Distributed Test Files • 2/22/2011

6. Future TPA Tasks • Distribute EFT Files • Collect manufacturer payor name as it will appear on Sponsor’s statements.

7. Invoice Correction Process (Draft) • Manufacturers wishing to correct an invoice may do so only if they have been invoiced for NDCs with labeler codes not covered by their CGDP Manufacturer Agreements. CMS publishes the “Participating Manufacturer Labeler Codes” at http://www.cms.gov/PrescriptionDrugCovGenIn/05_Pharma.asp#TopOfPage which documents the current list of labeler codes covered by each Manufacturer. Manufacturers submit their labeler codes at the time they sign the CGDP Manufacturer Agreement and maintain current labeler codes on an ongoing basis as described in “Medicare Coverage Gap Discount Program Guidance” CMS published on December 17, 2011. CMS uses “Participating Manufacturer Labeler Codes” to create the quarterly CGDP Invoice report. The quarterly report invoices Manufacturers for Labeler codes assigned to them as of the first business day following the end of the quarter. • To request an invoice correction the Manufacturer shall complete the information on the following slide and submit the invoice correction request to the TPA within five (5) days of the date the TPA distributes the CGDP Quarterly Invoice. The TPA will respond within 3 business days. If the TPA confirms the invoice correction, the manufacturer shall not be responsible for paying NDCs with labeler codes invoiced incorrectly. Instead the Manufacturer shall pay all other labeler codes in the invoice. The TPA will follow up with Part D sponsors and other affected Manufacturers to reissue invoices and confirm payment.

8. Invoice Correction Process (Draft) • Individual submitting Invoice Correction Request: • Manufacturer (name and P#) • Contact information: Email address Telephone number Address • Submission date (date invoice correction form submitted): • Date TPA distributed Quarterly Invoice Report • Report ID • Labeler Code(s) in question • Total dollars invoiced for Labeler Code(s) in question

9. Manufacturer Payment Confirmation Report Overview • Step 1: Manufacturers receive Invoice Report from TPA in their Outbound folder. • Manufacturers will be invoiced on a quarterly basis. • Step2: According to the terms in the Manufacturers’ Agreement, Part D Manufacturers will have 38 days to pay Sponsors in full. • The TPA will facilitate the funds transfer between the Manufacturers and Sponsors by providing Sponsor EFT information • Step 3: Manufacturers are required to send a confirmation of payment to the TPA. There is a five day window after payment is made to the sponsor. • Invoice report is a versatile format. With minimal change, Manufacturers convert the Invoice Report to the Confirmation of Payment report.

10. Manufacturer Confirmation Payment Report Creation Steps Steps to create Confirmation of Payment Report from Invoice Report: • Add File date to Manufacturer Header Record (TPAMH): Field 8- Date Confirmation Report will be returned • Manufacturers have a Contract Trailer Record for each contract they must pay. On each Contract Trailer (TPACT) populate: Field 12 - DATE OF PAYMENT Field 13 - PAYMENT AMOUNT • On the Manufacturers P Number Trailer (TPAMT) populate: Field 12 - DATE OF PAYMENT Field 13 - PAYMENT AMOUNT • At this time the Confirmation Report will need to change from “10MIV” to “10MPC” in field 6 of the TPAMH, field 6 of the TPACH, field 6 of the TPACT and field 6 of the TPAMT records. • Rename the file as follows R.#######.RPT.MANUF_CONFIRM The ####### is a sequential number the Manufacturer received on their Manufacturers Invoice Report. 6. Save the file as either a flat file or a text file. You can use a text editor like Wordpad, Notepad or Textpad to create the text file. 7. Send the new file to your Inbound folder.

11. Manufacturer Payment Confirmation File Layout

12. Manufacturer Payment Confirmation: P Number Header and Contract Header TPAMH TPACH

13. Manufacturer Payment Confirmation:Contract Trailer TPACT

14. Manufacturer Payment Confirmation: P Number Trailer TPAMT

15. Frequently Asked Questions • Invoice Data • EFT • Labeler Code • Third Party Vendor Roles

16. Dispute Process – Overview (Draft) • Dispute Reports: Proposed model is similar to payment confirmation report model (File formats to be developed.) • Manufacturer uses Manufacturer Data report to create the Dispute Submission file • TPA uses Dispute Submission Report to create Dispute Reply Report

17. Dispute Process Approach (Draft) • For each CGPD record disputed, Manufacturer submits • Dispute Reason Code; examples • DUP – duplicate • OTH - other • Data specific for individual Dispute Reason Code • Optional text field with additional information to further explain the dispute • Optional comment record to further explain the dispute(s). Each comment record has a unique identifier which the manufacturer associates with each dispute described in the comment record. • TPA replies with dispute reply code(s).

18. Sample Dispute: Duplicate gap discount record (Draft) Dispute Submission Report Dispute Reason Code: DUP Data to support dispute: Detail Reference Number Text field: optional Comment record - optional unique identifier (required if comment record is submitted.) Dispute Reply Report Dispute reply code: