Manufacturers Webinar March 2, 2011

Agenda Invoice Correction Process Payment Confirmation Process Frequently Asked Questions Dispute Process Questions and Answers

Announcements Connectivity reminder from TPA When sending emails to the TPA please include the P Number in the subject line of the email Thank everyone who has established connectivity. For the few that have not completed connectivity we urge you to do so in order to receive test files.

Webinar Schedule April 6th, 2011 4:00-5:00 p.m. ET May 4th, 2011 4:00-5:00 p.m. ET June 1st, 2011 4:00-5:00 p.m. ET July 6th, 2011 4:00-5:00 p.m. ET

Accomplishments Released EFT template 2/8/2011 Updated Manufacturer's Report layout 2/23/2011 Distributed Test Files 2/22/2011

Future TPA Tasks Distribute EFT Files Collect manufacturer payor name as it will appear on Sponsor’s statements.

Invoice Correction Process (Draft) Manufacturers wishing to correct an invoice may do so only if they have been invoiced for NDCs with labeler codes not covered by their CGDP Manufacturer Agreements. CMS publishes the “Participating Manufacturer Labeler Codes” at http://www.cms.gov/PrescriptionDrugCovGenIn/05_Pharma.asp#TopOfPage which documents the current list of labeler codes covered by each Manufacturer. Manufacturers submit their labeler codes at the time they sign the CGDP Manufacturer Agreement and maintain current labeler codes on an ongoing basis as described in “Medicare Coverage Gap Discount Program Guidance” CMS published on December 17, 2011. CMS uses “Participating Manufacturer Labeler Codes” to create the quarterly CGDP Invoice report. The quarterly report invoices Manufacturers for Labeler codes assigned to them as of the first business day following the end of the quarter. To request an invoice correction the Manufacturer shall complete the information on the following slide and submit the invoice correction request to the TPA within five (5) days of the date the TPA distributes the CGDP Quarterly Invoice. The TPA will respond within 3 business days. If the TPA confirms the invoice correction, the manufacturer shall not be responsible for paying NDCs with labeler codes invoiced incorrectly. Instead the Manufacturer shall pay all other labeler codes in the invoice. The TPA will follow up with Part D sponsors and other affected Manufacturers to reissue invoices and confirm payment. Thank you Anna. I’d like to share some information about the draft invoice correction process we have developed. (then read slide)

Invoice Correction Process (Draft) Individual submitting Invoice Correction Request: Manufacturer (name and P#) Contact information: Email address Telephone number Address   Submission date (date invoice correction form submitted): Date TPA distributed Quarterly Invoice Report Report ID Labeler Code(s) in question Total dollars invoiced for Labeler Code(s) in question In order to process an invoice correction the following information will need to be sent to the TPA. This information is in draft and the final procedures will be released in the near future.

Manufacturer Payment Confirmation Report Overview Step 1: Manufacturers receive Invoice Report from TPA in their Outbound folder. Manufacturers will be invoiced on a quarterly basis. Step2: According to the terms in the Manufacturers’ Agreement, Part D Manufacturers will have 38 days to pay Sponsors in full. The TPA will facilitate the funds transfer between the Manufacturers and Sponsors by providing Sponsor EFT information Step 3: Manufacturers are required to send a confirmation of payment to the TPA. There is a five day window after payment is made to the sponsor. Invoice report is a versatile format. With minimal change, Manufacturers convert the Invoice Report to the Confirmation of Payment report.

Manufacturer Confirmation Payment Report Creation Steps Steps to create Confirmation of Payment Report from Invoice Report: Add File date to Manufacturer Header Record (TPAMH): Field 8- Date Confirmation Report will be returned Manufacturers have a Contract Trailer Record for each contract they must pay. On each Contract Trailer (TPACT) populate: Field 12 - DATE OF PAYMENT Field 13 - PAYMENT AMOUNT On the Manufacturers P Number Trailer (TPAMT) populate: At this time the Confirmation Report will need to change from “10MIV” to “10MPC” in field 6 of the TPAMH, field 6 of the TPACH, field 6 of the TPACT and field 6 of the TPAMT records. Rename the file as follows R.#######.RPT.MANUF_CONFIRM The ####### is a sequential number the Manufacturer received on their Manufacturers Invoice Report. 6. Save the file as either a flat file or a text file. You can use a text editor like Wordpad, Notepad or Textpad to create the text file. 7. Send the new file to your Inbound folder.

Manufacturer Payment Confirmation File Layout Legend: Record Type Code Record Description Notes TPAMH Manufacturer P Number Header Used to provide TPA overall Payment completion TPACH Contract Header LBLR Manufacturer Total at the Labeler Level TPACT Contract Trailer Used to provide TPA Payment Confirmation to Contract TPAMT Manufacturer P Number Trailer Manufacturer Payment Confirmation Report TPAMH Return for TPA Payment Confirmation TPACH LBLR TPACT TPAMT Return for Overall Payment Confirmation

Manufacturer Payment Confirmation: P Number Header and Contract Header TPAMH Field NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUES 1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPAMH" 2 REPORT ID 6 - 11 9(6) 6 Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3 SEQUENCE NO 12 - 18 9(7) 7 An incrementing batch sequence number that starts at 0000001. 4 DDPS SYSTEM DATE 19 - 26 9(8) 8 ‘CCYYMMDD’ = DDPS File creation date. DDPS SYSTEM TIME 27 - 32 ‘HHMMSS’ = DDPS File creation time. FILE ID 33 - 37 10MPC - Manufacturer Payment Confirmation MANUFACTURER P NUMBER 38 - 42 The CMS assigned manufacturer P-Number FILE DATE 43 - 50 Date the Manufacturer sends the Confirmation of Payment Report to the TPA. (To be filled in when returning file to TPA for payment confirmation. ) 9 FILLER 51 - 200 X(150) 150 Spaces TPACH FIELD NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUE 1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPACH" 2 REPORT ID 6 - 11 9(6) 6 Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3 SEQUENCE NO 12 - 18 9(7) 7 An incrementing batch sequence number that starts at 0000001. 4 DDPS SYSTEM DATE 19 - 26 9(8) 8 ‘CCYYMMDD’ = DDPS File creation date. DDPS SYSTEM TIME 27 - 32 ‘HHMMSS’ = DDPS File creation time. FILE ID 33 - 37 10MPC - Manufacturer Payment Confirmation SUBMITTING CONTRACT NUMBER 38 - 42 The contract that submitted the Gap Discount PDEs FILLER 43 - 200 X(158) 158 Spaces

Manufacturer Payment Confirmation: Contract Trailer TPACT FIELD NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUES 1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPACT" 2 REPORT ID 6 - 11 9(6) 6 Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3 SEQUENCE NO 12 - 18 9(7) 7 An incrementing batch sequence number that starts at 0000001. 4 DDPS SYSTEM DATE 19 - 26 9(8) 8 ‘CCYYMMDD’ = DDPS File creation date. DDPS SYSTEM TIME 27 - 32 ‘HHMMSS’ = DDPS File creation time. FILE ID 33 - 37 10MPC - Manufacturer Payment Confirmation SUBMITTING CONTRACT NUMBER 38 - 42 The contract that submitted the Gap Discount PDEs DETAIL RECORD COUNT 43 - 49 The number of Labeler records for this Contract. 9 TOTAL REPORTED GAP DISCOUNT PREVIOUS AMOUNT 50 - 63 S9(12)V99 14 Reported Gap Discount that was reported on preceding Data Report 10 TOTAL REPORTED GAP DISCOUNT CURRENT AMOUNT 64 - 77 New Gap Discount amounts invoiced this quarter. 11 TOTAL GAP DISCOUNT AMOUNT THIS PERIOD 78 - 91 Net payment amount this quarter,calculated as the "current amount" minus the "previous amount" 12 DATE OF PAYMENT 92 - 99 Date payment was paid. If payments were made on multiple days, use final payment date 13 PAYMENT AMOUNT 100 - 113 Amount of payment made. If payments were made on multiple days, use the sum of all payments. EFT INDIVIDUAL IDENTIFICATION NUMBER 114 - 128 X(15) 15 A descriptive identifier that should be used by the manufacturer as the Individual Identification Number on the EFT Payment that is made to Contracts. Contracts should be able to identify the payment from the manufacturers on their banking records using this number. Format is: "CG" + Year/Quarter (i.e. "YYQQ") + Manufacturer P Number missing the P (i.e."8888") + Contract Number (i.e. "H1234") Example: "CGYYQQ8888H1234" FILLER 129 - 200 X(72) 72 Spaces

Manufacturer Payment Confirmation: P Number Trailer TPAMT FIELD NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUES 1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPAMT" 2 REPORT ID 6 - 11 9(6) 6 Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13". 3 SEQUENCE NO 12 - 18 9(7) 7 An incrementing batch sequence number that starts at 0000001. 4 DDPS SYSTEM DATE 19 - 26 9(8) 8 ‘CCYYMMDD’ = DDPS File creation date. DDPS SYSTEM TIME 27 - 32 ‘HHMMSS’ = DDPS File creation time. FILE ID 33 - 37 10MPC - Manufacturer Payment Confirmation MANUFACTURER P NUMBER 38 - 42 The CMS assigned manufacturer P-Number DETAIL RECORD COUNT 43 - 49 The number of Contracts this Manufacture will pay (i.e. count of TPACT records.) 9 TOTAL REPORTED GAP DISCOUNT PREVIOUS AMOUNT 50 - 63 S9(12)V99 14 Reported Gap Discount that was reported on preceding Data Report 10 TOTAL REPORTED GAP DISCOUNT CURRENT AMOUNT 64 - 77 New Gap Discount amounts invoiced this quarter. 11 TOTAL GAP DISCOUNT AMOUNT THIS PERIOD 78 - 91 Net payment amount this quarter,calculated as the "current amount" minus the "previous amount" 12 DATE OF PAYMENT 92 - 99 Date of last payment for this invoice. If payments were made on multiple days, use final payment date. (To be filled in when returning file to TPA for payment confirmation.) 13 PAYMENT AMOUNT 100 - 113 Total amount of payments made for this invoice. (To be filled in when returning file to TPA for payment confirmation.) FILLER 114 - 200 X(87) 87 Spaces

Frequently Asked Questions Invoice Data EFT Labeler Code Third Party Vendor Roles

Dispute Process – Overview (Draft) Dispute Reports: Proposed model is similar to payment confirmation report model (File formats to be developed.) Manufacturer uses Manufacturer Data report to create the Dispute Submission file TPA uses Dispute Submission Report to create Dispute Reply Report Dispute Timeline for 1st Quarter CGDP Reports TPA distributes CGDP quarterly reports April 30, 2011 Manufacturer submits disputes to TPA (report distribution date + 60 days) June 29, 2011 TPA sends dispute reply report (report distribution date + 120 days) August 29, 2011

Dispute Process Approach (Draft) For each CGPD record disputed, Manufacturer submits Dispute Reason Code; examples DUP – duplicate OTH - other Data specific for individual Dispute Reason Code Optional text field with additional information to further explain the dispute Optional comment record to further explain the dispute(s). Each comment record has a unique identifier which the manufacturer associates with each dispute described in the comment record. TPA replies with dispute reply code(s).

Sample Dispute: Duplicate gap discount record (Draft) Dispute Submission Report Dispute Reason Code: DUP Data to support dispute: Detail Reference Number Text field: optional Comment record - optional unique identifier (required if comment record is submitted.) Dispute Reply Report Dispute reply code: