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Reconciliation Services
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With the M/Care Recon+ and RxRecon options customers
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can automatically generate the IntegriGuard file to correct |
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demographic information (age, sex, hospice, ESRD, part A |
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coverage, Institutionalized, and Medicaid). This file will then |
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be available for download to the Plan or electronically |
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transmitted by M/Care to IntegriGuard. Letters to be sent to |
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the Beneficiary for SSA corrections will also be generated. |
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This process will enable Plans to track these discrepancies |
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and submit them for correction in a much quicker and more |
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efficient manner. Recon+ and RxRecon will provide you the |
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tools to reconcile your payments from CMS on a monthly |
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basis. Our new Reconciliation Services will provide you |
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with reports detailing critical information including |
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the following: |
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Payment |
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- PartC and PartD Payment Summary
- PartC and PartD Payment Discrepancies Detail
- Payment Discrepancies Aging
- Payment Extract
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Indicator
Discrepancies |
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- ESRD
- Hospice
- Institutionalized
- Medicaid
- Nursing Home
- Working Aged
- Part A or Part B Indicator Discrepancies
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Other
Discrepancy Reports |
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- Age Group or Gender Discrepancies
- County Code Discrepancies
- Out of Area Discrepancies
- Disease Groups Discrepancies
- Enrollment Discrepancies
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Other Reports |
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- No Match on CMS Roster
- No Match on CMS Monthly Membership
- Risk Adjustment Factor
- PDE reports
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