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Plan Revenue Reconciliation
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Identify payment discrepancies down to the member level |
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Revenue Discrepancy and reconciliation report library |
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Reconcile MMR discrepancies with CMS |
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Reconcile beneficiary HCC and RCC-Rx scores RAF |
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Set up
- Enter CMS, plan, PBP and segment information
in to Voyager
- Import core system data in to Voyager
- Enrollment
- PDE
- HCC
- Rx-HCC
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Calculate
- Calculate internal forecasts
- Member level HCC and HCC-Rx scores
- Prospective A/B and D reimbursements
and subsidies based on internal data or use CMS scores
- Import CMS
Data for comparison
- MMR
- CBSR
- Plan Payment File
- COB
- LIS
- Approved PDEs
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Compare
- Compare internal demographic data,
member status, scores and expected prospective payments with
CMS reports
- Generate discrepancies and create work queue items in work
queues
- Resolution
- CMS is Correct – Update internal systems of record
and re-import internal data to clear discrepancy work queue
items
- Internal
Systems are Correct – Create IntegriGuard documentation
to submit retro adjustments to CMS systems. Pend work queue
item and create expected future adjustment
- Irresolvable – Close
work queue items that cannot be resolved with reason codes
to track and categorize discrepancy write-offs.
- Close
- Monthly close process end the reconciliation process each
month and carries forward any outstanding discrepancies
to the next month
- Reconcile
- Calculate expected reconciliation amounts at year end
based on prospective reimbursements compared to what
should have been reimbursed
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| Voyager’s Revenue Reconciliation Module
provides the ability to: |
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Store all the CMS, plan, contract, PBP, segment, bid and
business assumptions for the payment year |
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Import all key internal data sets for comparison with CMS |
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Import all key CMS reports for comparison with internal data and
calculations |
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Calculate monthly prospective reimbursements and subsidies
for Part A/B and D at the member, segment, PBP, contract and plan
level |
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Compare internal and external results to identify discrepancies |
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Correct internal systems data or submit retro corrections
to CMS via
IntegriGuard or write-off |
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Calculate year end reconciliation amounts of prospective
vs. final reimbursements
and subsidies |
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Dynamic’s revenue reconciliation provides you the dynamic
reporting
you need to manage your revenue |
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