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Home » How To... » Submit Costs And Request Payment » Complete Payment Setup

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How To Complete Payment Setup - Updated 01/31/2008

The following document describes the process and step-by-step instructions on how to complete Payment Setup for the RDS Program using the RDS Secure Web Site.

Specifically, this document includes information about the following:

• What is Payment Setup?
• What drug cost data is required by the RDS Center?
• What is a Cost Reporter?
• How will costs be reported to the RDS Center?
• What is a Vendor?
• How does a Vendor obtain a Vendor ID?
• What is a Payment Requester?
• Can the same individual report costs and request payment on an application?
• What payment-related privileges can be assigned to the Authorized Representative?
• What payment-related privileges can be assigned to the Account Manager?
• What payment-related privileges can be assigned to a Designee?
• What is the difference between a Plan Sponsor Designee/Cost Reporter and a Vendor Designee/Cost Reporter?
• Can a single benefit option have more than one cost reporter?
• How, when, and to whom is information about Payment Setup communicated?
• How do I identify if my application is ready for Payment Setup?
• My application has been approved. Why can't I access Payment Setup?
• Do I have to complete the six payment setups in numerical order?
• Who can perform Payment Setup?
• What if I do not complete the Payment Setup process? Can I still request payment?
• How do I complete Payment Setup?
• What happens after Payment Setup is completed?
• Once a Cost Reporter submits a Cost Report, are there limitations to what can be changed in Payment Setup?

What is Payment Setup?

During the Payment Setup process the Plan Sponsor will be asked to identify individuals and/or Vendors that will be responsible for reporting costs associated with each benefit option and requesting payments for approved applications.

The Payment Process consists of six steps:

1. Assign Payment Requester Privilege to Authorized Representative
2. Assign Payment/Cost Privilege to Account Manager
3. Assign Payment/Cost Privilege to Designee(s)
4. Specify Vendors for Cost Reporting
5. Assign Benefit Options to Cost Reporters
6. Final Review to Complete Payment Setup

What drug cost data is required by the RDS Center?

The following drug claim data is required by the RDS Center, aggregated for all applicable retirees and reported monthly: gross retiree costs, threshold/limit reductions, and estimated cost adjustments for sponsors reporting gross retiree costs. For sponsors choosing to report estimated premiums for fully insured plans, the cost data will only include the estimated premium amounts, and the estimated cost adjustments will either be reported with the estimated premium amounts, or reported separately.

Cost data that is reported to the RDS Center will never be at the drug claim level. For interim cost reporting it will be reported per month, with all the retiree cost data aggregated for that month. At reconciliation it will be at a retiree level, but never at a claim level.

What is a Cost Reporter?

A Cost Reporter is an individual, or a Vendor, that is responsible for submitting drug cost data to the RDS Center. During the Payment Setup process, you will identify cost reporters for each benefit option defined within an application. You may choose to make any of the following cost reporters: the Account Manager, any existing designees already associated with the application, any new designees you would like to add to the application, or a Vendor(s). Cost reporters are assigned for each benefit option within an application, and each benefit option must have a cost reporter for the Payment Setup process to be complete.

How will costs be reported to the RDS Center?

There are two cost reporting submission methods: manual data entry via the RDS Secure Web Site and mainframe.

Manual Data Entry via the RDS Secure Web Site – This process requires an RDS Secure Web Site user to log into the RDS Secure Web Site and manually enter the aggregated retiree cost data per benefit option into the cost data spreadsheet.

Mainframe – This process requires a Vendor or a Sponsor to submit aggregated retiree cost data per benefit option using a mainframe-to-mainframe connection. Cost data sent via the mainframe will be viewable in the Secure Web Site; however, you will be unable to change cost data reported via the mainframe using the RDS Secure Web Site. To revise cost data submitted via the mainframe, you would need to submit revised cost data files using the mainframe connection and this new data will display on the RDS Secure Web Site.

If you are using a Vendor to report costs via the mainframe, you may assign one of their employees as a Designee with Payment Request or Cost Reporting privileges (i.e., an RDS Secure Web Site user) so the Vendor may view the cost report data files on the RDS Secure Web Site that they have submitted via the mainframe.

What is a Vendor?

A Vendor is a Pharmacy Benefit Manager (PBM), Health Plan, or another third party company that has been contracted by a Plan Sponsor(s) to report costs. During the Payment Setup process, a sponsor will be asked to specify any Vendors that are reporting costs for the application, and the submission method(s) the Vendor will be using. Using a Vendor to report cost data is optional.

A Vendor may report costs using mainframe or data entry cost report submission methods - this may vary from application to application. However, a Vendor is required to request a Vendor ID from the RDS Center, and each Vendor ID has a pre-associated cost data submission method as specified by the Vendor. For example, if Vendor ABC is reporting cost for application number 12345 using the mainframe cost submission method, Vendor ABC will need to request a Vendor ID from the RDS Center for the mainframe submission method. If Vendor ABC is also reporting costs for application 67890 using the data entry submission method, they will need to request an additional Vendor ID associated with the data entry submission method. As the Vendor works with multiple sponsors, they will need to use the Vendor ID that is appropriate for the cost submission requested by the sponsor.

How does a Vendor obtain a Vendor ID?

Vendors wanting to request Vendor IDs for the RDS Secure Web Site will need to call the RDS Center. To initiate the registration process, the Vendor needs to call the RDS Help Line for assistance. Once the Vendor receives the Vendor ID, he will need to communicate that Vendor ID number to the appropriate sponsor(s) so it can be entered in the RDS Secure Web Site as applicable.

If a Vendor currently has a Vendor ID related to the RDS retiree file processing, the plan is to let them use their current Vendor ID; however, they still need to call the RDS Center for confirmation. If a Vendor plans on submitting cost data both mainframe and data entry, they will need a Vendor ID for each cost reporting method.

What is a Payment Requester?

A Payment Requester is an individual that has been granted the permission to build and submit payment requests using the RDS Secure Web Site. The payment requester privilege is assigned at the application level. The Authorized Representative for the Plan Sponsor will always have the payment request privilege for all the applications to which he is associated. In addition to the Authorized Representative, other individuals may be assigned the payment request privilege as applicable. During Payment Setup you will be asked to identify any individual(s) that have permission to request payments for a specific application.

Can the same individual report costs and request payment on an application?

No. A single individual may not have both the report costs and request payment privileges on a given application. A cost reporter cannot request payments, and a payment requester cannot report costs. This separation of duties is to protect the RDS program against fraud, and protect taxpayer dollars. The RDS Secure Web Site will enforce this separation of duties requirement during the Payment Setup process.

Consequently, the Authorized Representative will always be a payment requestor on an application, and cannot ever report costs. Likewise, the Account Manager must decide if he wants to report costs or request payment - but cannot perform both payment-related privileges in the same application. The separation of duties requirement is at an application level so it is possible for an Account Manager or Designee to report costs on one application, and request payment on another if necessary.

What payment-related privileges can be assigned to the Authorized Representative?

Since the Authorized Representative is the only individual who may submit the annual or reconciliation payment request, he will always have the request payment privilege. During the Payment Setup process, the Authorized Representative is automatically granted the request payment privilege and, therefore, cannot also be a cost reporter. In addition, the Authorized Representative will have the ability to view interim cost reports for all benefit options. The Authorized Representative will not have the ability to report costs for any benefit option.

What payment-related privileges can be assigned to the Account Manager?

Since the same individual cannot both report costs and request payment for the same application, during the Payment Setup process, you will be asked to identify the payment-related privilege for the Account Manager. The Account Manager can either: request payment and consequently only view cost data, or report costs and consequently only view payment data, or only view both cost and payment data.

What payment-related privileges can be assigned to a Designee?

The "submit/view payment data" designee privilege has been replaced by two payment-related privileges: report costs and request payment. A Designee can be assigned either the report costs or the request payment privilege, but not both in the same application. You can either decide to assign payment-related privileges (report costs or request payment) to existing designees already defined in the application, or you can assign new designees during the Payment Setup process.

Designees assigned the report cost privilege will also have the ability view cost data for the benefit option(s) to which they are associated. Designees assigned the request payment privilege will be permitted to request payment, and view all cost reports for that application. Sponsors wanting Vendors to report cost data for them using the data entry cost report submission method will need to assign an employee of the Vendor as a Designee. You are not required to assign Designees as cost reporters or payment requestors - this is only necessary if someone other than the Authorized Representative and the Account Manager will be handling either one of the payment privileges.

What is the difference between a Plan Sponsor Designee/Cost Reporter and a Vendor Designee/Cost Reporter?

A Vendor Designee/Cost Reporter is an individual that is associated with a specific Vendor ID, and is given permission during the Payment Setup process to view or report cost data for a specific benefit option. A Sponsor Designee/Cost Reporter is an individual assigned the cost reporting privilege for a benefit option that is not assigned a Vendor ID.

Can a single benefit option have more than one cost reporter?

Yes, if necessary. At least one cost reporter must be assigned to each benefit option; however, it is also possible to have more than one. A single benefit option can have multiple cost reporters. The cost reporters could be two different Vendor IDs, two different Sponsor Designee/Cost reporters, or a combination of the two. Although multiple cost reporters can report costs for the same benefit option, he will only be able to view the cost data in the application on which they are reporting.

If multiple Sponsor Designee/Cost Reporters are reporting costs for the same benefit option, they must all use the same cost report data submission method. They must all use the mainframe, or data entry cost report submission method for that benefit option—not a combination of the two. This only applies to cost data being reported by multiple Sponsor Designee/Cost Reporters - not Vendors.

How, when, and to whom is information about Payment Setup communicated?

When the Payment Setup is completed and submitted to the RDS Center for processing, the following e-mail is generated.

How do I identify if my application is ready for Payment Setup?

Only applications with an Approved application status will have the ability to select the Payment Setup option as seen below.

My application has been approved. Why can't I access Payment Setup?

If an application has been approved (Application Status field indicates Approved as shown above), but the Authorized Representative and Account Manager does not have access to the Payment Setup Menu page, please call the RDS Help Line for assistance. Or send an e-mail to rds@cms.hhs.gov. 

Do I have to complete the six payment setups in numerical order?

Not necessarily, however, the RDS Center strongly recommends you complete the steps in the numerical order in which they are displayed on the Payment Setup menu. We believe completing them in this order will reinforce understanding the Payment Setup process, and how the individuals and/or entities assigned to the payment-related privileges are associated.

1. Assign Payment Requester Privilege to Authorized Representative
2. Assign Payment/Cost Privilege to Account Manager
3. Assign Payment/Cost Privilege to Designee(s)
4. Specify Vendors for Cost Reporting
5. Assign Benefit Options to Cost Reporters
6. Final Review to Complete Payment Setup

Who can perform Payment Setup?

The Authorized Representative and/or Account Manager are the only RDS Secure Web Site user roles that have the authority to perform Payment Setup. The Authorized Representative and/or Account Manager will be required to complete each of the six Payment Setup steps, and submit the complete Payment Setup steps to the RDS Center for processing.

What if I do not complete the Payment Setup process? Can I still request payment?

No. Performing the Payment Setup process is a precondition to requesting payment in the RDS Secure Web Site.

How do I complete Payment Setup?

1. Log into the RDS Secure Web Site.

   

2. From the Plan Sponsor List with Application Summary page, select the Plan Sponsor ID to which you want to complete Payment Setup.

   

3. From the Application List page, find the Application Number (e.g. App Number 102151) to which you want to complete Payment Setup. To access Payment Setup, click the Payment Setup link under the Payment Setup Status column or select the Payment Setup action from the Actions dropdown list and click Go.

   Note: You will not have access to Payment Setup until your application has an Application Status value of Approved.

   

   The Payment Setup page will display. At anytime after the Payment Setup process, you are able to view the details of your selected Payment Setup by clicking the View Payment Setup Options link.

   

4. Completing the six Payment Setup Steps.
• Step 1: Assign Payment Requester Privilege to Authorized Representative

  Step 1 has automatically been completed; hence the green checkmark and Complete Status. The Authorized Representative's payment-related privilege will always default to request payment, and cannot be changed. However, the Authorized Representative is not required to request payment. As you will see during this payment setup process, the Account Manager or a Designee can also be assigned the payment requesting privilege for an application.

• Step 2: Assign Payment/Cost Privilege to Account Manager

  The Plan Sponsor is required to assign the Account Manager one of the following privileges:

  • Cost Reporting - the Account Manager is allowed to report interim costs for this application.
  • Payment Requesting – the Account Manager is allowed to request interim payments for this application.
  • View Only – (Default) the Account Manager is only allowed to view interim costs and interim payment requests.

  

  Select the appropriate radio button and click Continue. Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

• Step 3: Assign Payment/Cost Privilege to Designee(s)

  The Plan Sponsor may choose to assign Designee(s) one of the following privileges:

  • Payment Requesting
  • Cost Reporting

  

  To assign the Payment/Cost privileges to a Designee (you will be able to assign payment-related privileges of cost reporting or payment requesting to either an existing designee, or you will be able to add one later), select Yes and click Continue.

  If you do not want to assign a payment-related privilege to a Designee, select No and click Continue. By not assigning a Designee, it is assumed the Authorized Representative or the Account Manager will be requesting payment, and either the Account Manager (only if he is not requesting payment) or a Vendor will be providing cost data. If either of these assumptions is incorrect, you will need to repeat the step and select Yes.

  Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  Once you have selected Yes, you do want to assign Designees payment-related privileges, you will see two possible scenarios depending on whether your application already has Designees associated with it, or not.

• Scenario 1: No Designee(s) have been assigned to the application

  To add a new Designee so you can assign him a payment-related privilege, click the Add a Designee link.

  Click Continue to return to the Payment Setup Menu page.

  

  If you click the Add a Designee link, the Add a Designee page will display.

  

  Enter the Designee's e-mail address.

  

  Click Assign New to add a new Designee or click Modify Search to enter a different e-mail address.

  

  Click Continue when you're finished assigning a Designee. Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  

  The E-PHI Agreement will display. You must click I Accept in order to assign the Designee. Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  

  Refer to How to Assign or Delete Designees for more information on how to add a Designee.

• Scenario 2: Designee(s) have already been assigned to the application.

  A list of Designees will display. If you decide you would like to assign payment-related privileges to a Designee other than what is currently displaying, you can always follow the Add a New Designee process. There is always the option of adding more Designees.

  

  To view a Designee's details, click on the Designee's name and a pop-up window will appear.

  

  If when you originally added the Designee you did not assign a payment privileges, you can do so at this time. Select the Change Privilege option from the Actions dropdown list and click Go.

  

  The Designee Information page will display.

  

  Select the payment privilege you want to assign to this Designee and click Continue.

  

  You will be asked to confirm your selection. Click Continue to assign the selected privilege or click Cancel to return to the Assign Payment/Cost Privileges to Designee(s) page.

  After you click Continue, you will be asked to confirm your selection. To approve your selection click Confirm. If you do not want to confirm your selection, click Cancel. Clicking Cancel will return you to the Assign Payment/Cost Privileges to Designee(s) page.

  

  After clicking Confirm, the E-PHI Agreement will display. Click I Accept to agree or click Cancel to return to the confirmation page.

• Step 4: Specify Vendors for Cost Reporting

  To specify a vendor the cost reporting privilege, select Yes and click Continue. If you do not want to specify a Vendor this privilege, select No and click Continue. In order to complete this step, you must select one of the options. Clicking Cancel will delete your selection, return you to the Payment Setup Menu page, and Step 4 will be incomplete.

  If you select No, Step 4 is complete and no other information is necessary.

  If you select Yes, you will be asked to provide additional information about the Vendor.

  

  After selecting Yes, you are prompted to specify a vendor.

  

  Click the Specify a Vendor link and the Specify Vendor page will display. Clicking Continue will return you to the Payment Setup Menu page.

  

  Enter the Vendor ID and click Go.

  Note: If you do not know the Vendor ID, contact the Vendor directly for this information. Make sure you clarify with the Vendor, which cost reporting submission method you would like them to use. The Vendor ID may vary depending on whether the Vendor is reporting mainframe or data entry.

  

  If the Vendor ID was found in the RDS Center database and you have confirmed that the information listed is correct, click Assign.

  Once a Vendor is assigned to the application, the Vendor Summary page displays.

  For each Vendor assigned, you will need to let the RDS Center know if you plan on having a Designee to view the cost reports submitted by the specific Vendor. Assigning a Designee to view cost reports submitted by a Vendor is optional; however, answering the question is not.

  Click the Identify Vendor Cost Reporters link under the Cost Reporters column or select the Identify Cost Reporters option for the Actions dropdown list and click Go.

  

  To identify Vendor Cost Reporters, select Yes and click Continue otherwise, select No and click Continue. In order to complete this step, you must select one of the options.

  If the Vendor is reporting mainframe, Vendor Cost Reporters will be allowed to view on the RDS Secure Web Site those cost reports submitted by the Vendor for the application.

  If the Vendor is reporting data entry, Vendor Cost Reporters will be allowed to enter costs on the RDS Secure Web Site on behalf of the Vendor. A Vendor Cost Reporter must be assigned if the Vendor is reporting data entry.

  Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  

  If the desired Designee is not listed, clicking on the Assign Designee(s) Payment Cost Privileges link will return you to Step 3 Assign Payment/Cost Privilege to Designee(s).

  If the desired designee is listed, select the appropriate checkbox and click Continue (you will return to the Payment Setup Menu page). Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  

• Step 5: Assign Benefit Options to Cost Reporters

  At this point in the Payment Setup process, you have assigned the Account Manager, Designees, and/or Vendors payment-related privileges, including cost reporting. Step 5: Assign Benefit Options to Cost Reporters will require you to for each benefit option, let the RDS Center know who will be providing that cost data and how (mainframe or data entry).

  If a listed Cost Reporter has not been assigned a reporting method and/or benefit option, select the appropriate action from the Actions dropdown list and click Go. Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  

• Action 1: Specify Reporting Method

  Select the appropriate radio button next to the cost reporting method you want to assign to the cost reporter and click Continue. Clicking Cancel will return you to the Payment Setup Menu page without saving your selection.

  

• Action 2: Assign Benefit Options

  To assign/unassign all listed benefit options click Assign All/Unassign All. To assign individual benefit options, check the appropriate box(es). Click Continue to save your choices and to return to the Assign Benefit Options to Cost Reporters page. Clicking Cancel will delete your selection and return you to the Assign Benefit Options to Cost Reporters page.

  

  After clicking Continue, you will return to the Assign Benefit Options to Cost Reporters page. When you're finished specifying reporting methods and assigning benefit options, click Continue. You will return to the Payment Setup Menu page.

  

• Step 6: Final Review to Complete Payment Setup

  At anytime during the Payment Setup process, you are able to view the details of your selected Payment Setup assignments by clicking the View Payment Setup Options link.

  To complete Payment Setup's final review, review each step:

  • The Authorized Representative was assigned the Payment Requester privilege.
    
    
  • The Account Manager has been assigned the Request Payment, Report Costs, or View Only privilege. If this step has not been completed, click on the Payment Setup link.
    
  • Designee(s) have been assigned the Report Costs privilege, Request Payment privilege, or not Payment/Cost Privileges. If this step has not been completed, click on the Payment Setup link.
    
  • Vendor(s) have been assigned the Cost Reporting privilege. If this step has not been completed, click on the Payment Setup link.
    
  • All Benefit Options have been assigned to at least Cost Reporter (person or Vendor). If this step has not been completed, click on the Payment Setup link.
    
  • If all six Payment Setup steps have been completed and you agree with the assignments, click Submit Payment Setup. If you want to change assignments or you do not want to submit your Payment Setup at this time, click Cancel.
    

  After clicking Submit Payment Setup, the following page will display.

  

  Once Step 6 has been complete, Payment Setup will be complete.

  

  The Authorized Representative and Account Manager will receive an e-mail confirmation.

  Cc: AR

  Dear AM,

  Congratulations! All steps of Payment Setup for the Medicare Retiree Drug Subsidy (RDS) program have been successfully completed for Application number [XXX application number] for [Marketing Solutions Group].

  Please logon to CMS' RDS Center web site [http://rds.cms.hhs.gov/] and select the "Payment Setup" action next to your application to view your Payment Setup options.

  We encourage you to continue visiting CMS' RDS Center Web Site for the most up-to-date information about the RDS program.

  If you have questions, please call CMS' RDS Help Line at (877) RDS-HELP, or (877) 737-4357. TTY for the hearing impaired: (877) RDS-TTY0, or (877) 737-8890. Or send an e-mail to rds@cms.hhs.gov. Additional information may also be found on CMS' RDS Program Web Site at: http://rds.cms.hhs.gov/.

  Sincerely,

  CMS' RDS Center

  Please Note: This e-mail message was sent from a notification-only address that cannot receive incoming e-mail, so please do not reply to the e-mail.

  If you want to change any Payment Setup options after Payment Setup has been completed, return to the Payment Setup Menu page, and revisit the appropriate step. Please note however, that if you do make a change to steps 2-4 you will be required to complete Step 6 and resubmit your updated Payment Setup assignments.

What happens after Payment Setup is completed?

After submitting your Payment Setup the Authorized Representative and Account Manager will receive an e-mail confirmation.

Once a Cost Reporter submits a Cost Report, are there limitations to what can be changed in Payment Setup?

Yes. The following actions will be prevented in Payment Setup once the Cost Reporter has submitted a Cost Report.

• Change Account Manager privilege from Report Costs to View Only or Request Payment.
• Change Plan Sponsor Designee privilege from Report Costs to Request Payment.
• Remove Vendor.
• Remove Benefit Options from Cost Reporters (Vendor or Plan Sponsor).