Register Now

Open and hide your control panel Join audio bull Choose ldquoMic amp Speakersrdquo to use VoIP bull Choose ldquoTelephonerdquo and dial using

the information provided

Submit questions and comments via the Questions panel

Note Todayrsquos presentation is being recorded and will be provided within 48 hours by email or by visiting httpwwwconsultparagoncomwebinars

Your Participation

Paragon is a professional services firm providing a full spectrum of consulting services from advisory through solution design and implementation for tighter alignment between business and IT

Leverages a proprietary set of methodologies and approaches to develop a pragmatic path to reaching business objectives

Provides application architecture and development project management and implementation integration services

Quick Facts

bull 550 Employees

bull Global Clients

bull NJ Headquarters

bull 5 US Offices amp 2 overseas

bull Dual-shore Development capability

bull Privately owned 32-year history

Principal Consultant Paragon Solutions Connect with Me bull Email sbermudezconsultparagoncom bull Read my blog bull Connect with me on Linkedin

Paragon is a professional services firm providing a full spectrum of consulting services from advisory through solution design and implementation for tighter alignment between business and IT

Leverages a proprietary set of methodologies and approaches to develop a pragmatic path to reaching business objectives

Provides application architecture and development project management and implementation integration services

Quick Facts

bull 550 Employees

bull Global Clients

bull NJ Headquarters

bull 5 US Offices amp 2 overseas

bull Dual-shore Development capability

bull Privately owned 32-year history

Principal Consultant Paragon Solutions Connect with Me bull Email sbermudezconsultparagoncom bull Read my blog bull Connect with me on Linkedin

Principal Consultant Paragon Solutions Connect with Me bull Email sbermudezconsultparagoncom bull Read my blog bull Connect with me on Linkedin

bull Current State - Negative Invoice Reconciliation bull Invoice Reconciliation - Negative Balance Solution

- New Plan Phase 1 - New Plan Phase 2

ndash Resulting Quarterly Invoice Process changes effective 1Q2014

bull What to expect in each phase bull What yoursquoll be required to do in each phase bull How to prepare for each phase bull The Business Process Impact

Are you aware of the CGDP 2014 invoice process changes and how

they will affect your business processes

bull On January 22 2014 CMS announced a ldquonew planrdquo for reconciling the negative invoices

bull New Plan = New Name - Invoice Reconciliation - Negative Balance Solution

bull October 31 2013 reports

were erroneous

bull Reports should be

discarded

bull Reports will not be

reissued

bull Payment should not have

been issued

The new plan for the Negative Balance Solution is a two phased approach

PHASE 1 PHASE 2

Reconciliation of negative invoices accrued between

1Q11 to 4Q13

Long term solution for reconciling on-going negative

invoices 1Q14 and beyond

bull On April 17 2014 the TPA will distribute negative invoice reconciliation reports

bull The reports will be collective and will reconcile negative

invoices accrued from 1Q2011 to 4Q2013 bull These reports will be distributed to all Manufacturers even if

negative invoices did not exist during these qtrs bull EFT payments from Sponsors to Manufacturers are due

within 38 days from distribution of invoices WH

AT

TO

EX

PE

CT

Track Receipt of Funds Confirm Receipt of Funds

bull Track receipt of EFT funds through AR system

bull Reconcile to Reports bull Summarize variances

bull Generate payment confirmation report bull Confirm receipt or non-receipt of funds for

negative invoice payments bull Note applicable amount on report bull Send payment confirmation report to TPA

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

Are you aware of the CGDP 2014 invoice process changes and how

they will affect your business processes

bull On January 22 2014 CMS announced a ldquonew planrdquo for reconciling the negative invoices

bull New Plan = New Name - Invoice Reconciliation - Negative Balance Solution

bull October 31 2013 reports

were erroneous

bull Reports should be

discarded

bull Reports will not be

reissued

bull Payment should not have

been issued

The new plan for the Negative Balance Solution is a two phased approach

PHASE 1 PHASE 2

Reconciliation of negative invoices accrued between

1Q11 to 4Q13

Long term solution for reconciling on-going negative

invoices 1Q14 and beyond

bull On April 17 2014 the TPA will distribute negative invoice reconciliation reports

bull The reports will be collective and will reconcile negative

invoices accrued from 1Q2011 to 4Q2013 bull These reports will be distributed to all Manufacturers even if

negative invoices did not exist during these qtrs bull EFT payments from Sponsors to Manufacturers are due

within 38 days from distribution of invoices WH

AT

TO

EX

PE

CT

Track Receipt of Funds Confirm Receipt of Funds

bull Track receipt of EFT funds through AR system

bull Reconcile to Reports bull Summarize variances

bull Generate payment confirmation report bull Confirm receipt or non-receipt of funds for

negative invoice payments bull Note applicable amount on report bull Send payment confirmation report to TPA

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

bull On January 22 2014 CMS announced a ldquonew planrdquo for reconciling the negative invoices

bull New Plan = New Name - Invoice Reconciliation - Negative Balance Solution

bull October 31 2013 reports

were erroneous

bull Reports should be

discarded

bull Reports will not be

reissued

bull Payment should not have

been issued

The new plan for the Negative Balance Solution is a two phased approach

PHASE 1 PHASE 2

Reconciliation of negative invoices accrued between

1Q11 to 4Q13

Long term solution for reconciling on-going negative

invoices 1Q14 and beyond

bull On April 17 2014 the TPA will distribute negative invoice reconciliation reports

bull The reports will be collective and will reconcile negative

invoices accrued from 1Q2011 to 4Q2013 bull These reports will be distributed to all Manufacturers even if

negative invoices did not exist during these qtrs bull EFT payments from Sponsors to Manufacturers are due

within 38 days from distribution of invoices WH

AT

TO

EX

PE

CT

Track Receipt of Funds Confirm Receipt of Funds

bull Track receipt of EFT funds through AR system

bull Reconcile to Reports bull Summarize variances

bull Generate payment confirmation report bull Confirm receipt or non-receipt of funds for

negative invoice payments bull Note applicable amount on report bull Send payment confirmation report to TPA

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

The new plan for the Negative Balance Solution is a two phased approach

PHASE 1 PHASE 2

Reconciliation of negative invoices accrued between

1Q11 to 4Q13

Long term solution for reconciling on-going negative

invoices 1Q14 and beyond

bull On April 17 2014 the TPA will distribute negative invoice reconciliation reports

bull The reports will be collective and will reconcile negative

invoices accrued from 1Q2011 to 4Q2013 bull These reports will be distributed to all Manufacturers even if

negative invoices did not exist during these qtrs bull EFT payments from Sponsors to Manufacturers are due

within 38 days from distribution of invoices WH

AT

TO

EX

PE

CT

Track Receipt of Funds Confirm Receipt of Funds

bull Track receipt of EFT funds through AR system

bull Reconcile to Reports bull Summarize variances

bull Generate payment confirmation report bull Confirm receipt or non-receipt of funds for

negative invoice payments bull Note applicable amount on report bull Send payment confirmation report to TPA

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

bull On April 17 2014 the TPA will distribute negative invoice reconciliation reports

bull The reports will be collective and will reconcile negative

invoices accrued from 1Q2011 to 4Q2013 bull These reports will be distributed to all Manufacturers even if

negative invoices did not exist during these qtrs bull EFT payments from Sponsors to Manufacturers are due

within 38 days from distribution of invoices WH

AT

TO

EX

PE

CT

Track Receipt of Funds Confirm Receipt of Funds

bull Track receipt of EFT funds through AR system

bull Reconcile to Reports bull Summarize variances

bull Generate payment confirmation report bull Confirm receipt or non-receipt of funds for

negative invoice payments bull Note applicable amount on report bull Send payment confirmation report to TPA

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

Track Receipt of Funds Confirm Receipt of Funds

bull Track receipt of EFT funds through AR system

bull Reconcile to Reports bull Summarize variances

bull Generate payment confirmation report bull Confirm receipt or non-receipt of funds for

negative invoice payments bull Note applicable amount on report bull Send payment confirmation report to TPA

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

Phase 1

bull Reconciliation of negative invoices accrued between 1Q11 to 4Q13

Phase 2 bull Long term

solution for reconciling on-going negative invoices 1Q14 and beyond

The new plan for the Negative Balance Solution is a two phased approach

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

bull Negative invoice amounts will continue to be included in standard invoice reports

bull As of 1Q14 Negative invoices will be resolved during the invoice quarter in which they are reported

bull Negative invoice balances will not be carried forward bull Sponsors will be required to pay negative invoice amounts

to Manufacturer at the time of the applicable invoice quarter

bull This will all occur within the standard 38 day processing window

bull This will result in changes to the quarterly invoice process WH

AT

TO

EX

PE

CT

Register Now

Register Now

Whatrsquos New bull EFT funds will flow both ways in a given quarter

bull New effective 1Q14 - Negative invoice amount = Sponsor sends funds to Manufacturer via EFT

bull Existing Process - Positive invoice amount = Manufacturer sends funds to Sponsor ndash no change from existing process

bull Sponsors can submit EFT funds to Manufacturer for negative invoices anywhere within the traditional CGDP 38 day payment cycle

Whatrsquos The Same bull Invoice file formats and layouts bull Timelines and deadlines for receipt and

submission bull Timelines and deadlines for payment to

sponsors and payment confirmation report to the TPA

bull Dispute Process

Paragon Solutions Inc Proprietary and Confidential

- 17 -

New in

2014

Process positive invoice

payments

Confirm payment of

invoices

Track receipt of negative invoice

payments

Confirm payment or non-payment

of negative invoices

Implement process to Confirm receipt of funds

Confirm payments received for negative invoices Confirm payments not received for negative

invoices Confirm payments made for positive invoices

Implement Reconciliation Process

Funds expected vs actual funds received Internal tracking vs TPA tracking Summarize amp report variances

Implement AR process to track receipt of funds

Identify amp allocate AR resources Create reports to support tracking Define overall AR process process timeline amp SLA

to track receipt of funds

Implement process to receive funds

Setndashup account to receive funds from Sponsors via EFT

Provide applicable EFT banking information to TPA Ensure AR system is equipped to receive EFT

funds for CGDP payments

Implement process to receive amp translate Negative Balance Reports

Evaluate file formats Determine process andor system changes Implement applicable changes

Applie

s to

Phase 1

amp

Phase 2

Ph

ase 1

On

ly

How prepared are you to respond to these changes

bullMultiple reports

bullManual Updates

bullConfirming payments in and out

bullAdditional Processing

bullSame 38 day timeframe

bullTracking Funds coming in

bullTracking funds going out

bullPhase 1 amp Phase2Qtrly Invoice Process

bullPhase 2 amp Standard Qtrly Invoice Process

Processing Overlap

EFT Funds Tracking

Payment Confirmation

Reports

Resource amp Time

Constraints

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

Whatrsquos The Same bull Invoice file formats and layouts bull Timelines and deadlines for receipt and

submission bull Timelines and deadlines for payment to

sponsors and payment confirmation report to the TPA

bull Dispute Process

Paragon Solutions Inc Proprietary and Confidential

- 17 -

New in

2014

Process positive invoice

payments

Confirm payment of

invoices

Track receipt of negative invoice

payments

Confirm payment or non-payment

of negative invoices

Implement process to Confirm receipt of funds

Confirm payments received for negative invoices Confirm payments not received for negative

invoices Confirm payments made for positive invoices

Implement Reconciliation Process

Funds expected vs actual funds received Internal tracking vs TPA tracking Summarize amp report variances

Implement AR process to track receipt of funds

Identify amp allocate AR resources Create reports to support tracking Define overall AR process process timeline amp SLA

to track receipt of funds

Implement process to receive funds

Setndashup account to receive funds from Sponsors via EFT

Provide applicable EFT banking information to TPA Ensure AR system is equipped to receive EFT

funds for CGDP payments

Implement process to receive amp translate Negative Balance Reports

Evaluate file formats Determine process andor system changes Implement applicable changes

Applie

s to

Phase 1

amp

Phase 2

Ph

ase 1

On

ly

How prepared are you to respond to these changes

bullMultiple reports

bullManual Updates

bullConfirming payments in and out

bullAdditional Processing

bullSame 38 day timeframe

bullTracking Funds coming in

bullTracking funds going out

bullPhase 1 amp Phase2Qtrly Invoice Process

bullPhase 2 amp Standard Qtrly Invoice Process

Processing Overlap

EFT Funds Tracking

Payment Confirmation

Reports

Resource amp Time

Constraints

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

Paragon Solutions Inc Proprietary and Confidential

- 17 -

New in

2014

Process positive invoice

payments

Confirm payment of

invoices

Track receipt of negative invoice

payments

Confirm payment or non-payment

of negative invoices

Implement process to Confirm receipt of funds

Confirm payments received for negative invoices Confirm payments not received for negative

invoices Confirm payments made for positive invoices

Implement Reconciliation Process

Funds expected vs actual funds received Internal tracking vs TPA tracking Summarize amp report variances

Implement AR process to track receipt of funds

Identify amp allocate AR resources Create reports to support tracking Define overall AR process process timeline amp SLA

to track receipt of funds

Implement process to receive funds

Setndashup account to receive funds from Sponsors via EFT

Provide applicable EFT banking information to TPA Ensure AR system is equipped to receive EFT

funds for CGDP payments

Implement process to receive amp translate Negative Balance Reports

Evaluate file formats Determine process andor system changes Implement applicable changes

Applie

s to

Phase 1

amp

Phase 2

Ph

ase 1

On

ly

How prepared are you to respond to these changes

bullMultiple reports

bullManual Updates

bullConfirming payments in and out

bullAdditional Processing

bullSame 38 day timeframe

bullTracking Funds coming in

bullTracking funds going out

bullPhase 1 amp Phase2Qtrly Invoice Process

bullPhase 2 amp Standard Qtrly Invoice Process

Processing Overlap

EFT Funds Tracking

Payment Confirmation

Reports

Resource amp Time

Constraints

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

Implement process to Confirm receipt of funds

Confirm payments received for negative invoices Confirm payments not received for negative

invoices Confirm payments made for positive invoices

Implement Reconciliation Process

Funds expected vs actual funds received Internal tracking vs TPA tracking Summarize amp report variances

Implement AR process to track receipt of funds

Identify amp allocate AR resources Create reports to support tracking Define overall AR process process timeline amp SLA

to track receipt of funds

Implement process to receive funds

Setndashup account to receive funds from Sponsors via EFT

Provide applicable EFT banking information to TPA Ensure AR system is equipped to receive EFT

funds for CGDP payments

Implement process to receive amp translate Negative Balance Reports

Evaluate file formats Determine process andor system changes Implement applicable changes

Applie

s to

Phase 1

amp

Phase 2

Ph

ase 1

On

ly

How prepared are you to respond to these changes

bullMultiple reports

bullManual Updates

bullConfirming payments in and out

bullAdditional Processing

bullSame 38 day timeframe

bullTracking Funds coming in

bullTracking funds going out

bullPhase 1 amp Phase2Qtrly Invoice Process

bullPhase 2 amp Standard Qtrly Invoice Process

Processing Overlap

EFT Funds Tracking

Payment Confirmation

Reports

Resource amp Time

Constraints

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

How prepared are you to respond to these changes

bullMultiple reports

bullManual Updates

bullConfirming payments in and out

bullAdditional Processing

bullSame 38 day timeframe

bullTracking Funds coming in

bullTracking funds going out

bullPhase 1 amp Phase2Qtrly Invoice Process

bullPhase 2 amp Standard Qtrly Invoice Process

Processing Overlap

EFT Funds Tracking

Payment Confirmation

Reports

Resource amp Time

Constraints

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

bullMultiple reports

bullManual Updates

bullConfirming payments in and out

bullAdditional Processing

bullSame 38 day timeframe

bullTracking Funds coming in

bullTracking funds going out

bullPhase 1 amp Phase2Qtrly Invoice Process

bullPhase 2 amp Standard Qtrly Invoice Process

Processing Overlap

EFT Funds Tracking

Payment Confirmation

Reports

Resource amp Time

Constraints

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

1Q14 April May June 7 14 21 28 5 12 19 26 2 9 16 23 30

Phase 1 Negative Invoice Reconciliation

Onetime Negative Invoice Recon Reports Distributed

Receive funds from Plan Sponsor for Negative Invoice Amts

Payment Confirmation Report Due to TPA for Negative Invoice Payments

Phase 2 Quarterly Invoice Process effective 1Q14

Updated EFT File Distributed 425

1Q14 Quarterly Invoices Distributed

1Q14 Quarterly Invoices Received

Invoice Correction Process if applicable

Payments Received for Negative Invoices in 1Q14 Sponsor Manufacturer

1Q14 Invoice Payments Due Manufacturer Sponsor

1Q14 Payment Confirmation Report Due to TPA

Standard Processing Deadlines New 2014 Process Changes for Negative Invoice

430

425

68

613

38 Day Payment Cycle

56 59

417

417 38 Day Payment Cycle 525

530

51

38 Day Payment Cycle 51

68

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

Data Management Requirements

Data Receipt Invoice Data Management

Detail Data Management

EFT File Management

Payment Requirements

Maintain EFT banking info for 600+ contracts

38 day processing

deadline

Send EFT payments for 600+

contracts

Reporting Requirements

Payment Confirmation

report

Operational Reports

Financial amp Trend Reports

Retain data for 17 quarters

Negative Balance Solution

Negative Invoice Reconciliation

Report

Maintain EFT info for receipt of

Negative Invoice payments

Receive EFT payments (Negative Invoices)

Confirm receipt of negative invoice

payments

The below figure illustrates the minimum high level requirements Manufacturers should have in place to support the administration amp processing of CGDP payments

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

TPA site

bull httptpadministratorcominternettpansfdocsCatHomeThird20P

arty20Administrator

Final Notice Negative Invoice Process

bull httptpadministratorcominternettpansffilesHPMS_MEMO_Negat

ive_Invoice_Process_Change_FINAL[1]pdf$FIleHPMS_MEMO_N

egative_Invoice_Process_Change_FINAL[1]pdf

If we do not get to your question during the webinar we will reach out to you directly with the answer

Principal Consultant Paragon Solutions bull Email sbermudezconsultparagoncom bull Read my blog bull Connect with me on Linkedin

Paragon Solutions Website

bull Paragon Life Sciences bull Government Pricing amp Revenue Management Practice

Social Media bull httpwwwfacebookcomparagonsolutions bull httpwwwtwittercomconsultparagon bull httpwwwlinkedincomcompanyparagon

Principal Consultant Paragon Solutions bull Email sbermudezconsultparagoncom bull Read my blog bull Connect with me on Linkedin

Paragon Solutions Website

bull Paragon Life Sciences bull Government Pricing amp Revenue Management Practice

Social Media bull httpwwwfacebookcomparagonsolutions bull httpwwwtwittercomconsultparagon bull httpwwwlinkedincomcompanyparagon

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