Vendor Management, Payments, and Collections (VMPC) FAQ
Guidance for FAQ regarding Payment Processing and General Information
Program Area: Vendor Management, Payments, and Collections (VMPC)
Question: Michael's coverage with issuer 21212 began on 1/1, but Michael thereafter terminated his plan on 1/10 retroactive back to 1/1. CMS already made payment of APTC and CSR for Michael's policy because it was included in issuer 21212's December template submission. How will CMS recover the payment already made for Michael's retroactively terminated policy?
Answer: Issuer 21212 will restate January effectuated enrollment data in the January template submission. This restatement will include all enrollments effective in January as of 1/15, which will no longer include Michael's enrollment with issuer 21212. CMS will therefore subtract the payment already made for Michael from Issuer 21212's February payment.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 16, 2014
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.