Products

Plan Revenue Reconciliation

Reconciliation
Identify data and process issues early that will impact your payments from CMS by identifying and tracking member, special status and payment discrepancies between your MMR and internal data.

	Identify payment discrepancies down to the member level
	Revenue Discrepancy and reconciliation report library
	Reconcile MMR discrepancies with CMS
	Reconcile beneficiary HCC and RCC-Rx scores RAF

	Set up Enter CMS, plan, PBP and segment information in to Voyager Import core system data in to Voyager Enrollment PDE HCC Rx-HCC
	Calculate Calculate internal forecasts Member level HCC and HCC-Rx scores Prospective A/B and D reimbursements and subsidies based on internal data or use CMS scores Import CMS Data for comparison MMR CBSR Plan Payment File COB LIS Approved PDEs
	Compare Compare internal demographic data, member status, scores and expected prospective payments with CMS reports Generate discrepancies and create work queue items in work queues Resolution CMS is Correct – Update internal systems of record and re-import internal data to clear discrepancy work queue items Internal Systems are Correct – Create IntegriGuard documentation to submit retro adjustments to CMS systems. Pend work queue item and create expected future adjustment Irresolvable – Close work queue items that cannot be resolved with reason codes to track and categorize discrepancy write-offs. Close Monthly close process end the reconciliation process each month and carries forward any outstanding discrepancies to the next month Reconcile Calculate expected reconciliation amounts at year end based on prospective reimbursements compared to what should have been reimbursed

Voyager’s Revenue Reconciliation Module provides the ability to:
	Store all the CMS, plan, contract, PBP, segment, bid and business assumptions for the payment year
	Import all key internal data sets for comparison with CMS
	Import all key CMS reports for comparison with internal data and calculations
	Calculate monthly prospective reimbursements and subsidies for Part A/B and D at the member, segment, PBP, contract and plan level
	Compare internal and external results to identify discrepancies
	Correct internal systems data or submit retro corrections to CMS via IntegriGuard or write-off
	Calculate year end reconciliation amounts of prospective vs. final reimbursements and subsidies
	Dynamic’s revenue reconciliation provides you the dynamic reporting you need to manage your revenue