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 s to the TPA please include the P Number in the subject line of the
Thank everyone who has established connectivity. For the few that have not completed connectivity we urge you to do so in order to receive test files.

4. Webinar Schedule April 6th, 2011 4:00-5:00 p.m. ET
May 4th, :00-5:00 p.m. ET
June 1st, :00-5:00 p.m. ET
July 6th, :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 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, 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.
Thank you Anna. I’d like to share some information about the draft invoice correction process we have developed. (then read slide)

8. Invoice Correction Process (Draft)
Individual submitting Invoice Correction Request:
Manufacturer (name and P#)
Contact information:
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
In order to process an invoice correction the following information will need to be sent to the TPA. This information is in draft and the final procedures will be released in the near future.

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:
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.
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.
Send the new file to your Inbound folder.

11. Manufacturer Payment Confirmation File Layout
Legend:
Record Type Code
Record Description
Notes
TPAMH
Manufacturer P Number Header
Used to provide TPA overall Payment completion
TPACH
Contract Header
LBLR
Manufacturer Total at the Labeler Level
TPACT
Contract Trailer
Used to provide TPA Payment Confirmation to Contract
TPAMT
Manufacturer P Number Trailer
Manufacturer Payment Confirmation Report
TPAMH
Return for TPA Payment Confirmation
TPACH
LBLR
TPACT
TPAMT
Return for Overall Payment Confirmation

12. Manufacturer Payment Confirmation: P Number Header and Contract Header
TPAMH
Field NO
FIELD NAME
POSITION
PICTURE
LENGTH
DEFINITION / VALUES 1
RECORD TYPE CODE
1 - 5
X(5) 5
"TPAMH" 2
REPORT ID
6 - 11
9(6) 6
Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3
SEQUENCE NO
9(7) 7
An incrementing batch sequence number that starts at 4
DDPS SYSTEM DATE
9(8) 8
‘CCYYMMDD’ = DDPS File creation date.
DDPS SYSTEM TIME
‘HHMMSS’ = DDPS File creation time.
FILE ID
10MPC - Manufacturer Payment Confirmation
MANUFACTURER P NUMBER
The CMS assigned manufacturer P-Number
FILE DATE
Date the Manufacturer sends the Confirmation of Payment Report to the TPA. (To be filled in when returning file to TPA for payment confirmation. ) 9
FILLER
X(150)
150
Spaces
TPACH
FIELD NO
FIELD NAME
POSITION
PICTURE
LENGTH
DEFINITION / VALUE 1
RECORD TYPE CODE
1 - 5
X(5) 5
"TPACH" 2
REPORT ID
6 - 11
9(6) 6
Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3
SEQUENCE NO
9(7) 7
An incrementing batch sequence number that starts at 4
DDPS SYSTEM DATE
9(8) 8
‘CCYYMMDD’ = DDPS File creation date.
DDPS SYSTEM TIME
‘HHMMSS’ = DDPS File creation time.
FILE ID
10MPC - Manufacturer Payment Confirmation
SUBMITTING CONTRACT NUMBER
The contract that submitted the Gap Discount PDEs
FILLER
X(158)
158
Spaces

13. Manufacturer Payment Confirmation: Contract Trailer
TPACT
FIELD NO
FIELD NAME
POSITION
PICTURE
LENGTH
DEFINITION / VALUES 1
RECORD TYPE CODE
1 - 5
X(5) 5
"TPACT" 2
REPORT ID
6 - 11
9(6) 6
Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3
SEQUENCE NO
9(7) 7
An incrementing batch sequence number that starts at 4
DDPS SYSTEM DATE
9(8) 8
‘CCYYMMDD’ = DDPS File creation date.
DDPS SYSTEM TIME
‘HHMMSS’ = DDPS File creation time.
FILE ID
10MPC - Manufacturer Payment Confirmation
SUBMITTING CONTRACT NUMBER
The contract that submitted the Gap Discount PDEs
DETAIL RECORD COUNT
The number of Labeler records for this Contract. 9
TOTAL REPORTED GAP DISCOUNT PREVIOUS AMOUNT
S9(12)V99 14
Reported Gap Discount that was reported on preceding Data Report 10
TOTAL REPORTED GAP DISCOUNT CURRENT AMOUNT
New Gap Discount amounts invoiced this quarter. 11
TOTAL GAP DISCOUNT AMOUNT THIS PERIOD
Net payment amount this quarter,calculated as the "current amount" minus the "previous amount" 12
DATE OF PAYMENT
Date payment was paid. If payments were made on multiple days, use final payment date 13
PAYMENT AMOUNT
Amount of payment made. If payments were made on multiple days, use the sum of all payments.
EFT INDIVIDUAL IDENTIFICATION NUMBER
X(15) 15
A descriptive identifier that should be used by the manufacturer as the Individual Identification Number on the EFT Payment that is made to Contracts. Contracts should be able to identify the payment from the manufacturers on their banking records using this number. Format is: "CG" + Year/Quarter (i.e. "YYQQ") + Manufacturer P Number missing the P (i.e."8888") + Contract Number (i.e. "H1234") Example: "CGYYQQ8888H1234"
FILLER
X(72) 72
Spaces

14. Manufacturer Payment Confirmation: P Number Trailer
TPAMT
FIELD NO
FIELD NAME
POSITION
PICTURE
LENGTH
DEFINITION / VALUES 1
RECORD TYPE CODE
1 - 5
X(5) 5
"TPAMT" 2
REPORT ID
6 - 11
9(6) 6
Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3
SEQUENCE NO
9(7) 7
An incrementing batch sequence number that starts at 4
DDPS SYSTEM DATE
9(8) 8
‘CCYYMMDD’ = DDPS File creation date.
DDPS SYSTEM TIME
‘HHMMSS’ = DDPS File creation time.
FILE ID
10MPC - Manufacturer Payment Confirmation
MANUFACTURER P NUMBER
The CMS assigned manufacturer P-Number
DETAIL RECORD COUNT
The number of Contracts this Manufacture will pay (i.e. count of TPACT records.) 9
TOTAL REPORTED GAP DISCOUNT PREVIOUS AMOUNT
S9(12)V99 14
Reported Gap Discount that was reported on preceding Data Report 10
TOTAL REPORTED GAP DISCOUNT CURRENT AMOUNT
New Gap Discount amounts invoiced this quarter. 11
TOTAL GAP DISCOUNT AMOUNT THIS PERIOD
Net payment amount this quarter,calculated as the "current amount" minus the "previous amount" 12
DATE OF PAYMENT
Date of last payment for this invoice. If payments were made on multiple days, use final payment date. (To be filled in when returning file to TPA for payment confirmation.) 13
PAYMENT AMOUNT
Total amount of payments made for this invoice. (To be filled in when returning file to TPA for payment confirmation.)
FILLER
X(87) 87
Spaces

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
Dispute Timeline for 1st Quarter CGDP Reports
TPA distributes CGDP quarterly reports
April 30, 2011
Manufacturer submits disputes to TPA (report distribution date + 60 days)
June 29, 2011
TPA sends dispute reply report (report distribution date days)
August 29, 2011

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: