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Among the many challenges facing Medicare plans today is the reconciliation process. Each month, plans compare their Part C and Part D membership data with data supplied by the Centers for Medicare and Medicaid Services (CMS) in order to identify and resolve any discrepancies. Data can vary significantly, and discrepancies can have a direct impact on plan revenue.
Identifying, tracking and resolving data discrepancies is time-consuming, typically requiring extensive manual labor and follow-up. Yet plans that don't take a thorough approach won't receive full payment.
TriZetto Plan Data Management offers a proven suite of Financial Reconciliation solutions. These solutions help plans identify, track and resolve discrepancies in support of the reconciliation process for Medicare Part C and Part D. The Financial Reconciliation suite of solutions includes these key applications:
- Reconciliation Manager. Helps Medicare plans track-from identification through resolution-any factor that may cause a payment discrepancy in Part C or Part D reimbursement.
- Special Status Identifier. Helps Medicare plans identify and track discrepancies regarding special-status designations, including end-stage renal disease (ESRD), institutionalized, working aged, and out of area.
- Risk Score Manager and Medicare Rx Risk Score Manager. Helps plans ensure that risk scores (on which reimbursements are based) are accurate.
- Pharmacy Reconciliation Manager. Tracks and calculates key data for Part D reconciliation.
Benefits
- Ensures that data is as clean and complete as possible before submission to CMS
- Helps identify and resolve discrepancies that can affect plan payment
- Tracks discrepancies through resolution
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Information
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For more detailed information, please call 1-800-569-1222 or click on the link below.
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