### Reconciliation Job Aid

Plan Sponsors may use this Reconciliation Job Aid to manage
reconciliation using the Reconciliation Checklist. The following are
some things to keep in mind during reconciliation:

-   In most cases, reconciliation can be initiated one day after the end
    of the plan year.  For details, go to: [When Can Plan Sponsors Begin
    Reconciliation?](http://www.rds.cms.hhs.gov/how_to/complete_recon.htm#begin) 
    Reconciliation **must** be completed by the application\'s
    reconciliation deadline. 

-   Plan Sponsors that elected an annual RDS payment frequency, or did
    not receive any interim payments, and wish to receive a single
    subsidy payment must use the Reconciliation Checklist to submit the
    payment request for the application.

-   Although a Plan Sponsor may have multiple applications, each
    application must be reconciled individually.

-   Reconciliation steps must be completed in numerical order by a user
    with the appropriate role (described below), but all steps may be
    accessed at any time in View Only mode. 

+--------+--------------+--------+------------------------+----------+
| **RDS  |              |        |                        |          |
| Re     |              |        |                        |          |
| concil |              |        |                        |          |
| iation |              |        |                        |          |
| Job    |              |        |                        |          |
| Aid**  |              |        |                        |          |
+========+==============+========+========================+==========+
| **Re   | **Purpose**  | **User | **Reminders**          | **       |
| concil |              | Role** |                        | Assigned |
| iation |              |        |                        | To & Due |
| Step** |              |        |                        | Dates**  |
+--------+--------------+--------+------------------------+----------+
| P      | Prepare all  | Indiv  | The application must   |          |
| repare | necessary    | iduals | be in \"Approved\" or  |          |
| for    | data and     | app    | \"Approved Appeal\"    |          |
| Re     | allocate all | ointed | status.                |          |
| concil | necessary    | by the |                        |          |
| iation | resources.   | Plan   | All desired interim    |          |
|        |              | S      | payment requests must  |          |
|        |              | ponsor | be submitted. (The     |          |
|        |              |        | maximum number of      |          |
|        |              |        | interim payment        |          |
|        |              |        | requests does not have |          |
|        |              |        | to be used before      |          |
|        |              |        | initiating             |          |
|        |              |        | reconciliation.)       |          |
|        |              |        |                        |          |
|        |              |        | Final rebate           |          |
|        |              |        | information must have  |          |
|        |              |        | been received.         |          |
|        |              |        |                        |          |
|        |              |        | All drug claims must   |          |
|        |              |        | have been processed    |          |
|        |              |        | and final cost data    |          |
|        |              |        | for the plan must have |          |
|        |              |        | been determined by     |          |
|        |              |        | communicating with all |          |
|        |              |        | cost reporters (e.g.,  |          |
|        |              |        | Vendors, Pharmacy      |          |
|        |              |        | Benefit Managers,      |          |
|        |              |        | etc.)                  |          |
|        |              |        |                        |          |
|        |              |        | All data about         |          |
|        |              |        | individual qualifying  |          |
|        |              |        | covered retirees must  |          |
|        |              |        | have been aggregated   |          |
|        |              |        | at the application     |          |
|        |              |        | level so that the cost |          |
|        |              |        | threshold and cost     |          |
|        |              |        | limit are              |          |
|        |              |        | appropriately applied  |          |
|        |              |        | against a retiree\'s   |          |
|        |              |        | cost data. For         |          |
|        |              |        | additional             |          |
|        |              |        | information, go to:    |          |
|        |              |        | [How Should            |          |
|        |              |        | Coordination of        |          |
|        |              |        | Individual Retiree     |          |
|        |              |        | Costs be               |          |
|        |              |        | Handle                 |          |
|        |              |        | d?](http://www.rds.cms |          |
|        |              |        | .hhs.gov/how_to/comple |          |
|        |              |        | te_recon.htm#handled). |          |
|        |              |        |                        |          |
|        |              |        | Decide who will submit |          |
|        |              |        | final cost reports.    |          |
|        |              |        | (Will they be the same |          |
|        |              |        | Cost Reporters that    |          |
|        |              |        | were active during     |          |
|        |              |        | interim cost           |          |
|        |              |        | reporting?)            |          |
|        |              |        |                        |          |
|        |              |        | Decide who should      |          |
|        |              |        | review and verify the  |          |
|        |              |        | final cost reports.    |          |
|        |              |        |                        |          |
|        |              |        | Decide who should      |          |
|        |              |        | finalize the           |          |
|        |              |        | reconciliation payment |          |
|        |              |        | request in Step 9 of   |          |
|        |              |        | the Reconciliation     |          |
|        |              |        | Checklist before the   |          |
|        |              |        | AR reviews the payment |          |
|        |              |        | request in Step 12 of  |          |
|        |              |        | the Reconciliation     |          |
|        |              |        | Checklist.             |          |
|        |              |        |                        |          |
|        |              |        | Decide who should      |          |
|        |              |        | review and/or update   |          |
|        |              |        | the existing           |          |
|        |              |        | Electronic Funds       |          |
|        |              |        | Transfer (EFT) banking |          |
|        |              |        | information.           |          |
|        |              |        |                        |          |
|        |              |        | Communicate the RDS    |          |
|        |              |        | reconciliation roles   |          |
|        |              |        | to all individuals     |          |
|        |              |        | involved and ensure    |          |
|        |              |        | they have the proper   |          |
|        |              |        | RDS Secure Web Site    |          |
|        |              |        | access.                |          |
|        |              |        |                        |          |
|        |              |        | Plan Sponsors should   |          |
|        |              |        | validate that all      |          |
|        |              |        | qualifying covered     |          |
|        |              |        | retiree information    |          |
|        |              |        | and subsidy periods    |          |
|        |              |        | are accurate by        |          |
|        |              |        | requesting,            |          |
|        |              |        | downloading, and       |          |
|        |              |        | reviewing the Covered  |          |
|        |              |        | Retiree List using the |          |
|        |              |        | Manage Retirees page.  |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Indicate to  | AR\    | 15 calendar days must  |          |
| 1:     | CMS\' RDS    | AM\    | have passed from the   |          |
| In     | Center that  | D/RP   | date of the last       |          |
| itiate | the Plan     | (View  | payment determination  |          |
| Re     | Sponsor is   | Only)  | before Step 1 can be   |          |
| concil | ready to     |        | initiated.             |          |
| iation | finalize the |        |                        |          |
|        | qualifying   |        | After this step is     |          |
|        | covered      |        | complete, it cannot be |          |
|        | retiree      |        | canceled or undone.    |          |
|        | list,        |        |                        |          |
|        | complete all |        | After this step is     |          |
|        | financial    |        | complete, interim cost |          |
|        | accounting   |        | reports and interim    |          |
|        | for          |        | payment requests are   |          |
|        | qualifying   |        | no longer accepted and |          |
|        | covered      |        | can no longer be       |          |
|        | retiree cost |        | appealed.              |          |
|        | data and     |        |                        |          |
|        | rebates, and |        | Final cost reports     |          |
|        | submit the   |        | will not be accepted   |          |
|        | final        |        | by CMS\' RDS Center    |          |
|        | re           |        | until Step 5 is        |          |
|        | conciliation |        | complete.              |          |
|        | payment      |        |                        |          |
|        | request to   |        | Mainframe cost         |          |
|        | CMS\' RDS    |        | reporters must be      |          |
|        | Center.      |        | advised that final     |          |
|        |              |        | cost data may not be   |          |
|        |              |        | reported until further |          |
|        |              |        | communication is       |          |
|        |              |        | received from the Plan |          |
|        |              |        | Sponsor.               |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Review       | AR\    | After Step 1 is        |          |
| 2:     | current      | AM\    | completed, Payment     |          |
| Review | payment      | D/RP   | Setup cannot be        |          |
| P      | setup        | (View  | modified through the   |          |
| ayment | options and  | Only)  | Application List page; |          |
| Setup  | determine    |        | it can only be         |          |
|        | who should   |        | modified through Step  |          |
|        | report final |        | 2.                     |          |
|        | cost data    |        |                        |          |
|        | and prepare  |        | This step may be       |          |
|        | the          |        | reopened at any time   |          |
|        | re           |        | during reconciliation  |          |
|        | conciliation |        | to change payment      |          |
|        | payment      |        | setup options;         |          |
|        | request, and |        | however, the step must |          |
|        | ensure those |        | have a status of       |          |
|        | individuals  |        | \"Completed\" in order |          |
|        | are included |        | to continue with any   |          |
|        | in the       |        | subsequent steps.      |          |
|        | payment      |        |                        |          |
|        | setup        |        | The Plan Sponsor       |          |
|        | options by   |        | should:                |          |
|        | adding       |        |                        |          |
|        | and/or       |        | -   Determine if any   |          |
|        | deleting     |        |     additional Cost    |          |
|        | them as      |        |     Reporters must be  |          |
|        | necessary.   |        |     added for final    |          |
|        |              |        |     cost reporting     |          |
|        |              |        |                        |          |
|        |              |        | -   Determine if any   |          |
|        |              |        |     Designees that     |          |
|        |              |        |     have the Request   |          |
|        |              |        |     Payment privilege  |          |
|        |              |        |     should not         |          |
|        |              |        |     participate in the |          |
|        |              |        |     preparation of the |          |
|        |              |        |     reconciliation     |          |
|        |              |        |     payment request    |          |
|        |              |        |                        |          |
|        |              |        | -   Determine if any   |          |
|        |              |        |     additional         |          |
|        |              |        |     Designees should   |          |
|        |              |        |     be granted the     |          |
|        |              |        |     Request Payment    |          |
|        |              |        |     privilege to allow |          |
|        |              |        |     preparation of the |          |
|        |              |        |     reconciliation     |          |
|        |              |        |     payment request    |          |
|        |              |        |                        |          |
|        |              |        | -   Determine if the   |          |
|        |              |        |     Designees          |          |
|        |              |        |     participating in   |          |
|        |              |        |     reconciliation     |          |
|        |              |        |     need Complete EFT  |          |
|        |              |        |     Information        |          |
|        |              |        |     privilege          |          |
|        |              |        |                        |          |
|        |              |        | -   Determine if the   |          |
|        |              |        |     Designees          |          |
|        |              |        |     participating in   |          |
|        |              |        |     reconciliation     |          |
|        |              |        |     need Retiree Data  |          |
|        |              |        |     privilege          |          |
|        |              |        |                        |          |
|        |              |        | After final cost data  |          |
|        |              |        | has been reported, the |          |
|        |              |        | following **cannot**   |          |
|        |              |        | be done:               |          |
|        |              |        |                        |          |
|        |              |        | Unassign a Vendor with |          |
|        |              |        | a Mainframe Reporting  |          |
|        |              |        | Method from a benefit  |          |
|        |              |        | option if that Vendor  |          |
|        |              |        | has reported cost      |          |
|        |              |        | data.                  |          |
|        |              |        |                        |          |
|        |              |        | Unassign AM or a D/RC  |          |
|        |              |        | from a benefit option  |          |
|        |              |        | if the Plan Sponsor    |          |
|        |              |        | has reported cost data |          |
|        |              |        | using mainframe and    |          |
|        |              |        | another Cost Reporter  |          |
|        |              |        | is not assigned to     |          |
|        |              |        | that benefit option.   |          |
|        |              |        |                        |          |
|        |              |        | Change the reporting   |          |
|        |              |        | method after cost data |          |
|        |              |        | have been reported.    |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Request a    | AR\    | The Plan Sponsor is    |          |
| 3:     | current list | AM\    | **REQUIRED** to review |          |
| R      | of           | D/RP\  | this list, and may     |          |
| equest | qualifying   | D/RP   | only submit cost data  |          |
| C      | covered      | /Retir | for the beneficiaries, |          |
| overed | retirees     | ee-may | benefit options, and   |          |
| R      | from CMS\'   | do     | subsidy periods        |          |
| etiree | RDS Center,  | wnload | included in the        |          |
| List   | download the | list   | covered retiree list.  |          |
|        | file from    |        |                        |          |
|        | the RDS      |        | This list is in a      |          |
|        | Secure Web   |        | Comma Separated Value  |          |
|        | Site and     |        | (CSV) format and       |          |
|        | verify the   |        | includes the same      |          |
|        | covered      |        | fields currently       |          |
|        | retiree      |        | required in RDS        |          |
|        | list.        |        | covered retiree        |          |
|        |              |        | reporting plus two     |          |
|        |              |        | additional fields that |          |
|        |              |        | will give reporting    |          |
|        |              |        | source information for |          |
|        |              |        | the convenience of the |          |
|        |              |        | Plan Sponsor.          |          |
|        |              |        |                        |          |
|        |              |        | The list can be        |          |
|        |              |        | requested multiple     |          |
|        |              |        | times, but can only be |          |
|        |              |        | requested once per     |          |
|        |              |        | day.                   |          |
|        |              |        |                        |          |
|        |              |        | The list will be       |          |
|        |              |        | available for download |          |
|        |              |        | using, the Manage      |          |
|        |              |        | Retirees page, within  |          |
|        |              |        | two business days      |          |
|        |              |        | after the request was  |          |
|        |              |        | made.                  |          |
|        |              |        |                        |          |
|        |              |        | The covered retiree    |          |
|        |              |        | eligibility            |          |
|        |              |        | information provided   |          |
|        |              |        | in this list should be |          |
|        |              |        | verified by the Plan   |          |
|        |              |        | Sponsor, especially if |          |
|        |              |        | multiple sources are   |          |
|        |              |        | reporting for an       |          |
|        |              |        | individual retiree.    |          |
|        |              |        |                        |          |
|        |              |        | After Step 4 is        |          |
|        |              |        | completed, additional  |          |
|        |              |        | covered retiree lists  |          |
|        |              |        | cannot be requested    |          |
|        |              |        | and the Plan Sponsor   |          |
|        |              |        | will only be able to   |          |
|        |              |        | report final cost data |          |
|        |              |        | for the beneficiaries, |          |
|        |              |        | benefit options, and   |          |
|        |              |        | subsidy periods listed |          |
|        |              |        | in the last requested  |          |
|        |              |        | covered retiree list.  |          |
|        |              |        |                        |          |
|        |              |        | A retiree may be       |          |
|        |              |        | covered under more     |          |
|        |              |        | than one benefit       |          |
|        |              |        | option within an       |          |
|        |              |        | application. If this   |          |
|        |              |        | occurs, cost reporting |          |
|        |              |        | for individual         |          |
|        |              |        | retirees must be       |          |
|        |              |        | coordinated to         |          |
|        |              |        | appropriately report   |          |
|        |              |        | threshold reductions   |          |
|        |              |        | and limit reductions.  |          |
|        |              |        | For additional         |          |
|        |              |        | information, go to:    |          |
|        |              |        | [How Should            |          |
|        |              |        | Coordination of        |          |
|        |              |        | Individual Retiree     |          |
|        |              |        | Costs be               |          |
|        |              |        | Handl                  |          |
|        |              |        | ed?](http://www.rds.cm |          |
|        |              |        | s.hhs.gov/how_to/compl |          |
|        |              |        | ete_recon.htm#handled) |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Agree with   | AR\    | The covered retiree    |          |
| 4:     | the          | AM\    | list agreed to in this |          |
| Fi     | be           | D/RP   | step provides the      |          |
| nalize | neficiaries, | (View  | basis of the           |          |
| R      | benefit      | Only)\ | reconciliation payment |          |
| etiree | options, and | D/     | request. Those         |          |
| List   | subsidy      | RP/Ret | retirees and their     |          |
|        | periods      | iree - | corresponding subsidy  |          |
|        | included in  | may    | periods will be the    |          |
|        | the covered  | do     | basis for the          |          |
|        | retiree      | wnload | reconciliation payment |          |
|        | list.        | list   | request.               |          |
|        |              | but    |                        |          |
|        |              | not    | If the Plan Sponsor    |          |
|        |              | co     | does not agree with    |          |
|        |              | mplete | some or all of the     |          |
|        |              | step   | records in the list,   |          |
|        |              |        | the Plan Sponsor may   |          |
|        |              |        | either resubmit the    |          |
|        |              |        | retiree records in     |          |
|        |              |        | question or submit a   |          |
|        |              |        | full retiree list to   |          |
|        |              |        | the RDS Center.        |          |
|        |              |        |                        |          |
|        |              |        | The Plan Sponsor will  |          |
|        |              |        | have the opportunity   |          |
|        |              |        | to work with CMS\' RDS |          |
|        |              |        | Center to resolve any  |          |
|        |              |        | covered retiree        |          |
|        |              |        | discrepancies.         |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Indicate     | AR     | After this step is     |          |
| 5:     | readiness to | (View  | completed the **Final  |          |
| Start  | start        | Only)\ | Costs** action can be  |          |
| Prepa  | sending      | AM\    | selected from the drop |          |
| ration | final cost   | D/RP   | down box on the        |          |
| of     | reports to   |        | Application List page. |          |
| Re     | CMS\' RDS    |        | Data entry final cost  |          |
| concil | Center for   |        | reports may be entered |          |
| iation | the          |        | through the **Final    |          |
| P      | application. |        | Costs** action much    |          |
| ayment |              |        | like interim costs     |          |
| R      |              |        | reports were.          |          |
| equest |              |        | Mainframe final cost   |          |
|        |              |        | reports will be        |          |
|        |              |        | submitted in the same  |          |
|        |              |        | file format as were    |          |
|        |              |        | interim cost reports.  |          |
|        |              |        | Final cost reports     |          |
|        |              |        | will continue to be    |          |
|        |              |        | accepted until Step 6  |          |
|        |              |        | is completed.          |          |
|        |              |        |                        |          |
|        |              |        | If cost reports are    |          |
|        |              |        | expected from Vendors  |          |
|        |              |        | using mainframe        |          |
|        |              |        | submission, the Plan   |          |
|        |              |        | Sponsor should get the |          |
|        |              |        | expected delivery date |          |
|        |              |        | for the final cost     |          |
|        |              |        | file submission from   |          |
|        |              |        | their Vendors.         |          |
|        |              |        |                        |          |
|        |              |        | Make sure all Cost     |          |
|        |              |        | Reporters are prepared |          |
|        |              |        | to submit final cost   |          |
|        |              |        | data corresponding to  |          |
|        |              |        | the agreed upon        |          |
|        |              |        | covered retiree list.  |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Monitor and  | AR     | The Plan Sponsor       |          |
| 6:     | verify       | (View  | should be aware of the |          |
| Manage | submission   | Only)\ | status of cost         |          |
| Subm   | of final     | AM\    | reporting from all     |          |
| ission | costs for    | D/RP   | Cost Reporters         |          |
| of     | the entire   |        | assigned to the        |          |
| Final  | application  |        | application.           |          |
| Cost   | and from all |        |                        |          |
| R      | cost         |        | When submitting final  |          |
| eports | reporting    |        | cost data, **all       |          |
|        | sources.     |        | months** must be       |          |
|        |              |        | re-reported for        |          |
|        |              |        | reconciliation.        |          |
|        |              |        | Previous interim cost  |          |
|        |              |        | reports cannot be used |          |
|        |              |        | for a given month even |          |
|        |              |        | if there are no        |          |
|        |              |        | changes.               |          |
|        |              |        |                        |          |
|        |              |        | Every benefit option   |          |
|        |              |        | with an interim        |          |
|        |              |        | payment greater than   |          |
|        |              |        | zero must have a       |          |
|        |              |        | corresponding final    |          |
|        |              |        | cost report that       |          |
|        |              |        | includes cost data for |          |
|        |              |        | all months of the plan |          |
|        |              |        | year. Zero cost data   |          |
|        |              |        | will be accepted.      |          |
|        |              |        |                        |          |
|        |              |        | Pay close attention to |          |
|        |              |        | the cost threshold and |          |
|        |              |        | cost limit for         |          |
|        |              |        | individual             |          |
|        |              |        | beneficiaries that are |          |
|        |              |        | covered under more     |          |
|        |              |        | than one benefit       |          |
|        |              |        | option and/or have     |          |
|        |              |        | cost data reported by  |          |
|        |              |        | more than one source   |          |
|        |              |        | to be sure that the    |          |
|        |              |        | calculation of cost    |          |
|        |              |        | data are coordinated   |          |
|        |              |        | within the             |          |
|        |              |        | application.  For      |          |
|        |              |        | additional             |          |
|        |              |        | information, go to:    |          |
|        |              |        | [How Should            |          |
|        |              |        | Coordination of        |          |
|        |              |        | Individual Retiree     |          |
|        |              |        | Costs be               |          |
|        |              |        | Handl                  |          |
|        |              |        | ed?](http://www.rds.cm |          |
|        |              |        | s.hhs.gov/how_to/compl |          |
|        |              |        | ete_recon.htm#handled) |          |
|        |              |        |                        |          |
|        |              |        | If submitting cost     |          |
|        |              |        | data for plan years    |          |
|        |              |        | that begin in calendar |          |
|        |              |        | year 2005, submit 2005 |          |
|        |              |        | drug cost data for     |          |
|        |              |        | qualifying covered     |          |
|        |              |        | retirees to be counted |          |
|        |              |        | toward the cost        |          |
|        |              |        | threshold and cost     |          |
|        |              |        | limit for 2006.        |          |
|        |              |        |                        |          |
|        |              |        | Estimated premiums     |          |
|        |              |        | cannot be submitted    |          |
|        |              |        | during reconciliation. |          |
|        |              |        | Actual drug cost data  |          |
|        |              |        | must be obtained and   |          |
|        |              |        | reported.              |          |
|        |              |        |                        |          |
|        |              |        | If multiple Cost       |          |
|        |              |        | Reporters are          |          |
|        |              |        | reporting final cost   |          |
|        |              |        | data, make sure the    |          |
|        |              |        | effort is coordinated  |          |
|        |              |        | since completion of    |          |
|        |              |        | this step prevents any |          |
|        |              |        | additional final cost  |          |
|        |              |        | reporting for all      |          |
|        |              |        | benefit options.       |          |
|        |              |        |                        |          |
|        |              |        | The Plan Sponsor       |          |
|        |              |        | should be working with |          |
|        |              |        | the Vendor to resolve  |          |
|        |              |        | all error conditions.  |          |
|        |              |        |                        |          |
|        |              |        | If cost reports are    |          |
|        |              |        | expected to be entered |          |
|        |              |        | using Data Entry, the  |          |
|        |              |        | Plan Sponsor should be |          |
|        |              |        | monitoring the status  |          |
|        |              |        | of each cost report to |          |
|        |              |        | ensure that no part of |          |
|        |              |        | the cost report is     |          |
|        |              |        | left in \"Data Entry:  |          |
|        |              |        | Saved\" status because |          |
|        |              |        | that is an indication  |          |
|        |              |        | that cost reporting is |          |
|        |              |        | not yet complete from  |          |
|        |              |        | that Cost Reporter.    |          |
|        |              |        |                        |          |
|        |              |        | When this step is in   |          |
|        |              |        | \"Complete\" status,   |          |
|        |              |        | cost reports will no   |          |
|        |              |        | longer be accepted.    |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Confirm all  | AR     | If more than one Cost  |          |
| 7:     | final cost   | (View  | Reporter is reviewing  |          |
| Review | reports for  | Only)\ | final cost data, make  |          |
| Final  | the          | AM\    | sure the effort is     |          |
| Costs  | application  | D/RP   | coordinated to ensure  |          |
|        | for each     |        | accuracy.              |          |
|        | benefit      |        |                        |          |
|        | option.      |        | It is expected that    |          |
|        |              |        | the Plan Sponsor will  |          |
|        |              |        | have internal          |          |
|        |              |        | supporting drug cost   |          |
|        |              |        | details and summarized |          |
|        |              |        | data that validates    |          |
|        |              |        | all final cost data    |          |
|        |              |        | being reported.        |          |
|        |              |        | Furthermore, it is     |          |
|        |              |        | expected that the Plan |          |
|        |              |        | Sponsor will compare   |          |
|        |              |        | the summarized data    |          |
|        |              |        | with the final cost    |          |
|        |              |        | reports that have been |          |
|        |              |        | submitted to ensure    |          |
|        |              |        | that the final cost    |          |
|        |              |        | data that could be     |          |
|        |              |        | included in the        |          |
|        |              |        | reconciliation payment |          |
|        |              |        | request are accurate.  |          |
|        |              |        |                        |          |
|        |              |        | If necessary, the Plan |          |
|        |              |        | Sponsor can decide to  |          |
|        |              |        | once again allow final |          |
|        |              |        | cost reporting using   |          |
|        |              |        | Step 6.                |          |
+--------+--------------+--------+------------------------+----------+
| Step   | State        | AR     | The ability to enter   |          |
| 8:     | whether      | (View  | cost revisions through |          |
| Enter  | final cost   | Only)\ | Step 8 is not          |          |
| Rev    | revisions    | AM\    | available at this      |          |
| isions | are          | D/RP   | time. Coordinating     |          |
| to     | necessary as |        | individual             |          |
| Final  | a result     |        | beneficiaries'         |          |
| Costs  | of:   (1)    |        | threshold and limit    |          |
|        | coordinating |        | reductions must be     |          |
|        | individual   |        | reported through Step  |          |
|        | ben          |        | 6, as must rebates and |          |
|        | eficiaries\' |        | other price            |          |
|        | threshold    |        | concessions received   |          |
|        | and limit    |        | directly from a drug   |          |
|        | reductions   |        | manufacturer by the    |          |
|        | and/or (2)   |        | Plan Sponsor.          |          |
|        | rebates or   |        |                        |          |
|        | other price  |        | Please keep in mind    |          |
|        | concessions  |        | that Step 6 must be    |          |
|        | (directly    |        | marked \"Allow Cost    |          |
|        | from a drug  |        | Reporting\" to enable  |          |
|        | manufacturer |        | cost reporters to      |          |
|        | to the Plan  |        | access the **Final     |          |
|        | Sponsor).    |        | Costs** action for     |          |
|        |              |        | data entry and for     |          |
|        |              |        | final mainframe cost   |          |
|        |              |        | reports to be          |          |
|        |              |        | accepted. Revising     |          |
|        |              |        | cost data in this      |          |
|        |              |        | manner eliminates the  |          |
|        |              |        | need to revise cost    |          |
|        |              |        | data using Step 8.     |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Agree that   | AR     | Plan Year Application  |          |
| 9:     | the final    | (View  | Summary and Benefit    |          |
| Fi     | payment      | Only)\ | Option Summary tables  |          |
| nalize | request is   | AM\    | show the               |          |
| the    | ready to be  | D/RP   | reconciliation payment |          |
| Re     | reviewed by  |        | request amount. If     |          |
| concil | the          |        | correct, select        |          |
| iation | Authorized   |        | **Submit**.            |          |
| P      | Repr         |        |                        |          |
| ayment | esentative.  |        | If the payment request |          |
| R      |              |        | amount is not correct, |          |
| equest |              |        | the Plan Sponsor must  |          |
|        |              |        | revisit Steps 6        |          |
|        |              |        | through 8 in order to  |          |
|        |              |        | correct the underlying |          |
|        |              |        | cost data.             |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Review and   | AR\    | If the current EFT     |          |
| 10:    | if           | AM\    | information is not     |          |
| Review | necessary,   | D/     | updated when           |          |
| Elec   | update EFT   | RP/EFT | completing Step 10,    |          |
| tronic | information  | D/RP   | Step 11 is             |          |
| Funds  | to ensure    | (No    | automatically          |          |
| Tr     | the          | A      | completed.             |          |
| ansfer | re           | ccess) |                        |          |
| (EFT)  | conciliation |        | EFT information        |          |
| Infor  | payment is   |        | provided by the Plan   |          |
| mation | deposited    |        | Sponsor must be for    |          |
|        | into the     |        | Automated Clearing     |          |
|        | correct      |        | House (ACH) deposits   |          |
|        | account.     |        | and NOT wire           |          |
|        |              |        | transfers.             |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Approve      | AR\    | If EFT information was |          |
| 11:    | revised EFT  | AM     | not updated when       |          |
| A      | information  | (View  | completing Step 10, no |          |
| pprove | for          | Only)\ | action is required for |          |
| C      | rec          | D      | this step.             |          |
| hanged | onciliation. | /RP(No |                        |          |
| Elec   |              | A      |                        |          |
| tronic |              | ccess) |                        |          |
| Funds  |              |        |                        |          |
| Tr     |              |        |                        |          |
| ansfer |              |        |                        |          |
| (EFT)  |              |        |                        |          |
| Infor  |              |        |                        |          |
| mation |              |        |                        |          |
+--------+--------------+--------+------------------------+----------+
| Step   | Review       | AR\    | Rejecting the payment  |          |
| 12:    | re           | AM     | request will require   |          |
| Review | conciliation | (View  | Step 9 through Step 11 |          |
| and    | payment      | Only)\ | to be completed again  |          |
| Submit | request and  | D/RP   | with any necessary     |          |
| Re     | submit or    | (View  | corrections.           |          |
| concil | reject the   | Only)  |                        |          |
| iation | request as   |        | This step is only      |          |
| P      | appropriate. |        | considered             |          |
| ayment |              |        | \"Complete\" if the AR |          |
| R      |              |        | accepts and submits    |          |
| equest |              |        | the reconciliation     |          |
|        |              |        | payment request.       |          |
|        |              |        |                        |          |
|        |              |        | After this step is     |          |
|        |              |        | complete,              |          |
|        |              |        | reconciliation is      |          |
|        |              |        | final and cannot be    |          |
|        |              |        | revised or canceled.   |          |
|        |              |        |                        |          |
|        |              |        | The reconciliation     |          |
|        |              |        | request will be        |          |
|        |              |        | processed by CMS\' RDS |          |
|        |              |        | Center and any monies  |          |
|        |              |        | owed will be deposited |          |
|        |              |        | using an ACH           |          |
|        |              |        | transaction to the     |          |
|        |              |        | bank account specified |          |
|        |              |        | in Step 10. If the     |          |
|        |              |        | request results in an  |          |
|        |              |        | overpayment (money is  |          |
|        |              |        | owed to the RDS        |          |
|        |              |        | Center), CMS will      |          |
|        |              |        | initiate proceedings   |          |
|        |              |        | to recover the funds.  |          |
+--------+--------------+--------+------------------------+----------+

**Abbreviation Glossary**

-   **ACH** -- Automated Clearing House

-   **AM** -- Account Manager

-   **AR** -- Authorized Representative

-   **CSV** - Comma Separated Value

-   **D/RC** -- Designee with Report Cost privilege

-   **D/RP** -- Designee with the Request Payment privilege

-   **D/RP/EFT** -- Designee with Request Payment and Electronic Funds
    Transfer privilege

-   **D/RP/Retiree** - Designee with Request Payment and Retiree Data
    privilege

-   **EFT** -- Electronic Funds Transfer

-   **PS** -- Plan Sponsor

-   **RDS** -- Retiree Drug Subsidy

-   **SWS** -- Secure Web Site