Offerings Organization benefits
This Medicare Eligibility and Plan Payment Reconciliation Tool that manages, reconciles, and reports the following CMS data files:

  • DTRR (Daily Transaction Reply Report)
    • Medicaid & LTI Indicators
  • MMR (Member Maintenance Report)
  • PPR (Plan Payment Report)
  • LEP (Late Enrollment Payment)
  • LIS (Low Income Subsidy)
  • Monthly Premium Withholding Report (MPWRD) Data File

Provides CMS with timely and accurate information regarding the beneficiaries’ enrollment, disenrollment, special membership status, and State and County Code changes.

Exports Reporting and Remediation/Aging tracking that summarizes:

  • Discrepancy type and aging
  • Plan vs CMS discrepancy
  • Timing issues
  • Research and remediation recommendations
  • Executed remediation actions

Retroactivity submissions (Category II and III)

Supports CMS required data processing in an efficient automated manner:

  • Daily and Monthly Reconciliation of the following Data:
    • Eligibility (incl. DTRR)
    • Plan Payment
    • Quarterly Attestations
  • Provides an effective tool to support identifying, tracking, and managing discrepancies between CMS and Plan Data to increase:
    • Eligibility and Plan Payment accuracy
    • CMS payment timeliness
    • Prompt remediation of eligibility and payment data discrepancies
  • Storing and updating of CMS Risk Adjustment Factor scores (RAF)
  • Identification of Operational Issues:
    • Processor
    • System Automation