Reconciliation Solution

CMS pays Medicare Advantage and Stand Alone Part D Plans on a prospective basis (in advance of the services provided). In Addition to the prospective payments, Plans receive retroactive adjustments each month based on new information sent to CMS that would affect the Plan’s payment. The details of the monthly prospective and retroactive adjustments are sent to the Plan in a detailed file called the Monthly Membership Report (MMR). The Plan has an obligation to CMS to review and correct Plan-identified discrepancies in payment. An officer of the Plan must attest that this work has been completed and all known discrepancies are identified and are being worked by the Plan.

The Voyager Reconciliation Module is designed to provide the tools required for a Plan to calculate an internal (Plan view) of monthly prospective and retrospective payment adjustments and determine where there are differences with the external (CMS view) view of payment as reported in the MMR.