CMS Gateway’s Reconciliation Module is the ultimate in automated, streamlined and integrated reconciliation processing. Daily, weekly and monthly reconciliation helps plans remain in compliance with CMS and increase the accuracy of membership, enrollment and payment data. Fewer discrepancies and more efficient discrepancy resolution combine to significantly reduce the resources required to perform time-consuming research and rework.

Key features of the Reconciliation Module include:

• Single point of data correction. CMS Gateway facilitates both membership and payment reconciliation by supplying a unified Web-based dashboard. Users can correct discrepancies, such as demographic, plan or special status, all without needing to access multiple applications.
• Streamlined data warehousing. All plan-to-CMS and CMS-to-plan files and data are archived in a structured database, extremely useful for research and auditing purposes because information is readily available at both plan and member levels.
• Advanced member reconciliation functionality. Features include:
• Daily, weekly and monthly membership reconciliation: BCSS, TRR, MMR and FEF
• CMS-to-plan discrepancy identification and resolution: SCC, PBP, LIS, demographics, etc.
• CMS special-status reconciliation
• Automated weekly and monthly maintenance TRR processing: HIC changes, etc.
• Letter generation
• Correction submission to CMS/IntegriGuard
• Advanced payment reconciliation functionality. Features include:
• Payment reconciliation: monthly plan payment files (MMR)
• Member, PBP, contract and MCO-level ledger reporting
• Management reporting for payments and adjustments
• Correction submission to CMS/IntegriGuard