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A Comprehensive Revenue Management System for Payers

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Membership and Payment Reconciliation

Recon+ (Part C) and Rx Recon (Part D) enable you to reconcile CMS monthly membership and payments to Plan membership and system calculated plan expected payments. Reports are produced to identify and correct enrollment, demographic, and payment discrepancies. CMS adjustments and Plan adjustments are processed to resolve the discrepancies.

Online-screens, batch reports, and extracts are available for your reference and audit purposes. Our Revenue360 tracks CMS and Plan payments and discrepancies at the Plan, PBP, and member level. Account receivables extracts can feed your financial system directly.

How will Recon+ (Part C) and Rx Recon (Part D) benefit your Plan?
  • Keeps compliance with the CMS 45-day attestation requirement
  • Identifies demographic and financial differences between Plan data and CMS data
  • Provides an early trigger to identify financial mismatches for Premium Billing, Part A, Part B, Direct Subsidy, and Coverage Gap
  • Enables automatic updates to your financial system with payment extracts and customized G/L feeds
  • Can be configured to work with Dual requirements
Part D Annual Reconciliation

Annual Reconciliation process reconciles previous and current year's estimated payments compared to the Plans actual PDE information.

How will Part D Annual Reconciliation benefit your Plan?
  • Ability to enter Direct and Indirect Remuneration (DDIR) information online
  • Total estimated payments for Reinsurance and LICS
  • Calculate actual Reinsurance, LICS, Risk Corridor based on PDEs