J.1.D Cash Collections Worksheet For HIGLAS Users.xlsx

XLSX spreadsheet 59 KB Posted Sep 4, 2019

Attached to: Part A/B Medicare Administrative Contractor, Jurisdiction E
Solicitation number: 75FCMC19R0023
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

About this file

Written by GovTribe AI · Dec 28, 2023

This document outlines a federal contract opportunity for Medicare Administrative Contractor services in Jurisdiction E. The Centers for Medicare and Medicaid Services intends to issue a Request for Proposal to obtain a contractor to provide specified health insurance benefit administration services including Medicare claims processing and payment for California, Hawaii, Nevada, American Samoa, Guam, and Northern Mariana Islands. The contractor will perform claims-related activities, establish provider relationships, and ensure financial integrity of the Medicare Fee-For-Service Program in accordance with applicable laws and regulations. The anticipated solicitation release date is September 4, 2019, with proposals due November 4, 2019 and award by August 4, 2020. The contract will include a base year plus six one-year options. This opportunity is expected to be issued pending availability of funds.

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File	Type	Posted
75FCMC19R0023_Amendment_2.pdf	PDF	Oct 17, 2019
Amendment_2,_Attachment_1_-_RFP_Question_Responses.xlsx	XLSX spreadsheet	Oct 17, 2019
JE_Amendment_1_CLEAN_Attachments_UPDATED.zip	ZIP file	Oct 8, 2019
Amendment_1,_Attachment_1_REDLINE_Backpages.pdf	PDF	Oct 8, 2019
JE_Amendment_1_REDLINED_Attachments_UPDATED.zip	ZIP file	Oct 8, 2019
JE_RFP_Questions_and_Responses_Amendment_1.xlsx	XLSX spreadsheet	Oct 8, 2019
75FCMC19R0023_Amendment_1.pdf	PDF	Oct 8, 2019
J.23 Government Provided Proposal Assumptions	—	Sep 4, 2019
J.39 CLIN 0006 Cost Proposal Template - Option Year 2	—	Sep 4, 2019
J.1.G AB MAC Performance Requirements Summary.docx	DOCX document	Sep 4, 2019
J.22 Basis of Estimate.xlsx	XLSX spreadsheet	Sep 4, 2019
J.42 CLIN 0009 Cost Proposal Template - Option Year 3	—	Sep 4, 2019
J.34 CLIN 0001 Cost Proposal Template - Implementation.xlsx	XLSX spreadsheet	Sep 4, 2019
J.1 Statement of Work	—	Sep 4, 2019
J.40 CLIN 0007 Cost Proposal Template - Option Year 2	—	Sep 4, 2019
J.28 Product Accessibility Template.docx	DOCX document	Sep 4, 2019
J.1.C Fee-For-Service Shared System Base Functions.docx	DOCX document	Sep 4, 2019
J.5 Government Systems Provided For Use.docx	DOCX document	Sep 4, 2019
J.46 CLIN 0013 Cost Proposal Template - Option Year 5	—	Sep 4, 2019
J.37 CLIN 0004 Cost Proposal Template - Option Year 1	—	Sep 4, 2019
J.45 CLIN 0012 Cost Proposal Template - Option Year 5	—	Sep 4, 2019
J.49 CLIN 0016 Cost Proposal Template - Outgoing Contractor Workload Transition Activities.xlsx	XLSX spreadsheet	Sep 4, 2019
J.10 Contractor Business Ethics COI and Compliance Program Requirements.docx	DOCX document	Sep 4, 2019
J.1.A List of Key Definitions.docx	DOCX document	Sep 4, 2019
J.23.A Government Provided Proposal Assumptions Audit and Reimbursement Tables.xlsx	XLSX spreadsheet	Sep 4, 2019
J.33 Cost Template Summary Sheet.xlsx	XLSX spreadsheet	Sep 4, 2019
J.23.B Government Provided Proposal Assumptions CSR-Handled Telephone Inquiries Tables.docx	DOCX document	Sep 4, 2019
75FCMC19R0023.pdf	PDF	Sep 4, 2019
J.11 Personal Conflicts of Interest Financial Disclosure.docx	DOCX document	Sep 4, 2019
J.2 Deliverable Schedule.docx	DOCX document	Sep 4, 2019
J.44 CLIN 0011 Cost Proposal Template - Option Year 4	—	Sep 4, 2019
J.24 Attestations.docx	DOCX document	Sep 4, 2019
J.47 CLIN 0014 Cost Proposal Template - Option Year 6	—	Sep 4, 2019
J.3 Small Business Subcontracting Plan Template.docx	DOCX document	Sep 4, 2019
J.35 CLIN 0002 Cost Proposal Template - Base Year	—	Sep 4, 2019
J.32 Systems of Records.docx	DOCX document	Sep 4, 2019
J.48 CLIN 0015 Cost Proposal Template - Option Year 6	—	Sep 4, 2019
J.7 AB MAC Award Fee Plan and Self Assessment Template.docx	DOCX document	Sep 4, 2019
J.25 Past Performance Questionnaire.docx	DOCX document	Sep 4, 2019
J.4 HHS Contracting Guide for Contract of Government Property.docx	DOCX document	Sep 4, 2019
J.41 CLIN 0008 Cost Proposal Template - Option Year 3	—	Sep 4, 2019
J.43 CLIN 0010 Cost Proposal Template - Option Year 4	—	Sep 4, 2019
J.9 Non-Disclosure Statement.docx	DOCX document	Sep 4, 2019
J.1.B List of Key Acronyms.docx	DOCX document	Sep 4, 2019
J.36 CLIN 0003 Cost Proposal Template - Base Year	—	Sep 4, 2019
J.38 CLIN 0005 Cost Proposal Template - Option Year 1	—	Sep 4, 2019
J.8 MAC Security Incident and Reportable Event Reporting and Response.docx	DOCX document	Sep 4, 2019
J.6 Contractor Furnished Property.docx	DOCX document	Sep 4, 2019

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Instructions

Cash Collections Worksheet (Subsequent Reporting Requirements)

Using the Summary 2 Trial Balance, obtain the amounts listed under the ‘Period Activity’ Columns.

(1) Calculate the Hospital Insurance (HI)/Supplementary Medical Insurance (SMI) percentage split.

The HI percentage split is calculated by the amount of the Fund 050961, SGL 119503 divided by the sum of Fund 050961, SGL 119503 and plus Fund 050960, SGL 119503.

Emily Norment: Emily Norment:

Unable to determine what SGL stands for

The SMI percentage split is calculated by the amount of the Fund 050960, SGL 119503 divided by the sum of Fund 050961, SGL 119503 plus Fund 050960, SGL 119503.

(2) Report on Line C, HI Monthly Cash Deposit, the amount of the Fund 050961, SGL 119503 plus the result of the HI percentage split multiplied by the amount of the Fund 050720, SGL 119503.

(3) Report on Line D, SMI Monthly Cash Deposit, the amount of the Fund 050960, SGL 119503 plus the SMI percentage split multiplied by the amount of the Fund 050720, SGL 119503.

Note: The amounts reported on Line C, HI Monthly Cash Deposit, and/or Line D, SMI Monthly Cash Deposit must equal the sum of the amount of Fund 0050720, SGL 119503, plus the amount of Fund 050961, SGL 119503, plus the amount of Fund 050960, SGL 119503.

HIGLAS contractors shall only enter amounts on Line C, HI Monthly Cash Deposit, and/or Line D, SMI Monthly Cash Deposit.

Line E, Chief Financial Officer (CFO) certification.

All other amount items (Lines) are blank or zero.

Please email completed/certified worksheet to CMS at cashcollection@cms.hhs.gov.

&"Arial,Bold"RFP # 75FCMC19R0023 &"Arial,Bold"&F Instructions

1/10/2019

Allowance

Contractor Name: Part B					LEGEND					Exhibit 1
						Warning: There could be an issue but there may not be.
Period Ending December 31, 2010						Issue: There is an issue such as missing data that needs to be resolved.
						This cell requires manual input
Allowance for Uncollectible Accounts Matrix
			NONFEDERAL-HI-MSP-CM-Registers-TOTAL	NONFEDERAL-HI-NONMSP-CM-Registers-TOTAL	NONFEDERAL-SMI-MSP-CM-Registers-TOTAL	NONFEDERAL-SMI-NONMSP-CM-Registers-TOTAL	NONFEDERAL-GEN-MSP-CM-Registers-TOTAL	NONFEDERAL-GEN-NONMSP-CM-Registers-TOTAL		NONFEDERAL-NA-NA-CM-TROR-TOTAL
			Col E	Col F	Col G	Col H	Col I	Col J
			HI Principal	HI Principal	SMI Principal	SMI Principal	General Fund	General Fund	Fund	TROR
Note: Amounts are from the Treasury Report on Receivables (TROR) Supporting Reports			MSP	NON-MSP	MSP	NON-MSP	MSP	NON-MSP	Total	Report	Check
	TROR Line Item	HIGLAS Detail Activity Report/Register Line
A	(1) Beginning Fiscal Year (FY) Balance	CMS Beginning Balance Report / (1) Beginning FY Balance	0	0	0	0	0	0	0	0	0
	(2) New Receivables (+)	CMS Transaction Register / LINE 2 NEW RECEIVABLES	0	0	0	12,715,571	0	0	12,715,571	12,715,571	0

(3) Accruals (+) (New Interest Receivables)						0	56,235		56,235	180,188	123,953
Transaction Register (support line 3)	CMS Transaction Register / LINE 3 ADJUSTMENT					0	56,235		56,235
Centers for Medicare & Medicaid Services (CMS) Adjustment Register (support line 3)	CMS Adjustment Register / LINE 3 Medicare Secondary Payer (MSP)/NONMSP ADJUSTMENT					0	0		0
(5) Adjustments		0	0	263.000	(189,677)	121	18,428		(170,865)	(170,865)	0
(A) Reclassified/Adjusted Amounts (+ or -)	CMS Accounts Receivable Reconciliation (AR) Adjustments Register / LINE 5A MSP/NONMSP ADJUSTMENT	0	0	0	(538,772)	0	(612)	0	(539,384)	(539,383)	-1
(B) Adjustments Due to Sale of Assets (+ or -)	CMS AR Adjustments Register / LINE 5B MSP/NONMSP ADJUSTMENT	0	0	0	0	0	0	0	0	0	0
(C) Consolidations (+ or -)	CMS AR Adjustments Register / LINE 5C MSP/NONMSP ADJUSTMENT	0	0	0	0	0	0	0	0	0	0
(D) Foreclosure Adjustments (+ or -)	CMS AR Adjustments Register / LINE 5D MSP/NONMSP ADJUSTMENT	0	0	0	0	0	0		0	0	0
(E) Written-Off Debts Reinstated for Collections (+)	CMS AR Adjustments Register / LINE 5E MSP/NONMSP ADJUSTMENT	0	0	263.000	349,095	121	19,040		368,519	368,518	1
(6) Amounts Written-Off (-)		0	0	0	(1,036,986)	0	(71,781)		(1,108,767)	(1,108,767)	0
(A) Currently Not Collectible (-)	CNC - CMS Adjustment Register / LINE 6A MSP/NONMSP ADJUSTMENT	0	0	0	(833,953)	0	(71,117)	0	(905,070)	(905,070)	0
(B) Written-Off and Closed Out (-)	CMS AR Adjustments Register / LINE 5E MSP/NONMSP ADJUSTMENT	0	0	0	(203,033)	0	(664)	0	(203,697)	(203,697)	0

Receivable Available to Be Collected 0 0 263.000 11,488,908 121 2,882 11,492,174 11,616,127 -123953

B	(4) Collections on Receivables (-)	CMS AR Applied Collections	263.000	10,786,074	121	70,611	10,857,069	10,857,069	0
	(A) At Agency		0	(10,606,769)	0	(43,429)	(10,650,198)	(10,650,198)	0
	(B) At Third Party		0	0	0	0	0	0	0
	(C) Asset Sales		0	0	0	0	0	0	0
	(D) Collections by Treasury through Offset and Cross-Servicing (-)		(263)	(179,305)	(121)	(27,182)	(206,871)	(206,870)	-1
	(E) Collections by Sales After Foreclosure (-)		0	0	0	0	0	0	0
	(F) Collections by Department of Justice (-)		0	0	0	0	0	0	0
	(G) Other - must footnote (-)		0	0	0	0	0	0	0

Collection Percentage n/a n/a 100.00% 93.88% 100.00% 2450.07% 94.47% 93.47%

C Allowance Percentage (1-collection %) n/a n/a 0.00% 6.12% 0.00% -2350.07% 5.53% 6.53%

D	Average of Allowance (current instruction require Medicare contractors to use five year historical allowance rate
		Average	n/a	n/a	11.00%	10.78%	0.00%	-2350.07%
		Current Period: Dec 31, 2010	n/a	n/a	0.00%	6.12%
		Sep 30, 2010	0.00%	0.00%	20.00%	15.00%
		Sep 30, 2009	0.00%	0.00%	10.00%	12.00%
		Sep 30, 2008	0.00%	0.00%	14.00%	10.00%
		Sep 30, 2007	n/a	n/a	n/a	n/a

E	(7) Ending Balance (TROR/Activity Registers)	Centers for Medicare & Medicaid Services (CMS) AR Overpayments Report	8,174,514	213,169	0	8,387,683	8,387,795	112
	Cost Report Settlements		0	0		0	0	0
	Claims Accounts Receivable		0	0		0	0	0
	Credit Balances		0	0		0	0	0
	Other (if cost reports issues include with cost reports)		0	0		0	0	0
	Physician/Supplier		8,129,931	213,169		8,343,100	8,343,100	0
	Beneficiary		44,583	0		44,583	44,583	0
	Periodic Interim Payment ('PIP) Accrual		0	0		0	0	0
	Group Health Plan (GHP)(Data/non-Data Match)		0	0		0	0	0
	MSP Prov/Phys/Supp/Bene		0	0		0	0	0
	MSP Beneficiary (Liability)		0	0		0	0	0
	Other MSP (Liability)		0	0		0	0	0
	Check		7471680	280,898		7752578	7628737	123841

(X1) Allowance Amount (Collection Percentage) n/a n/a 0 881,162 0 (5,009,619) (4,128,458)

(X2) Individual Account Analysis-Not Applicable for Carriers (Part B) *************************************** CMS has granted a Waiver for Carriers **************************************

(X3)	Delinquencies Exceeding 180 Days	CMS AR Overpayment Report where parameter "Allowance Calc(Over 180 Days Delinquent))"=Y	71	2,750,314	41	165,436	2,915,862	2,915,861	1
	Cost Report Settlements[180]		0	0	0	0	0	0	- 0
	Claims Accounts Receivable[180]		0	0	0	0	0	0	- 0
	Credit Balances[180]		0	0	0	0	0	0	- 0
	Other (if cost reports issues include with cost reports)[180]		0	0	0	0	0	0	- 0
	Physician/Supplier[180]		0	2,749,790	0	165,436	2,915,226	2,915,225	1
	Beneficiary[180]		0	524	0	0	524	524	- 0
	PIP Accrual[180]		0	0	0	0	0	0	- 0
	GHP(Data/non-Data Match)[180]		71	0	41	0	112	112	- 0
	MSP Prov/Phys/Supp/Bene[180]		0	0	0	0	0	0	- 0
	MSP Beneficiary (Liability)[180]		0	0	0	0	0	0	- 0
	Other MSP (Liability)[180]		0	0	0	0	0	0	- 0

F Estimated Allowance Amount ALLOWANCE USING THE MOST CONSERVATIVE AMOUNT 0 0 71 2,750,314 41 165,436 2,915,862

Amount Reported on Trial Balance per Allowance Matrix (Using the conservative amount):
		Amount
	Hospital Insurance (HI) MSP Allowance Amount	0
	HI NON-MSP Allowance Amount	0
	HI Total Allowance	0

Fund Acct# 05961 SGL#131901 SGL# 131901 - Allow For Loss on REC-PRINC - 0

Supplemental Medical Insurance (SMI) MSP Allowance Amount	(71)
SMI NON-MSP Allowance Amount	(2,750,314)
SMI Total Allowance	(2,750,385)

Fund Acct# 05960 SGL#131901 SGL# 131901 - Allow For Loss on REC-PRINC (2,750,385.00)

General Fund MSP Allowance	(41)
General Fund NON -MSP Allowance	(165,436)
General Fund Total Allowance	(165,477)

Fund Acct# 050720 SGL#134901 SGL# 134901 - Allow For Loss on REC-INT (165,477.00)

Note: HIGLAS Interest is not split between HI/SMI but MSP/non-MSP. Therefore, contractors shall compare the current interest collection percentage vs. the over 180 days delinquent amounts.

NOTES:

(*) The above amounts are the allowance estimates for loss on receivable for the period-to-date.

(**) Therefore, the estimated amounts are the calculated ending balances to be reported on the Summary 2 Trial Balance by SGL account by fund (Ending Balance Column).

(***) When Line A1, Receivables Available to be Collected by component is less then or equal to zero (0) the component estimated allowance amount must equal zero (0).

(****) When the estimated allowance is greater than the Line 7, Ending Balance (Line E - above by Fund), the reported allowance amount must equal the Line 7, Ending Balance (Line E - above by Fund).

&"Arial,Bold"RFP # 75FCMC19R0023 &"Arial,Bold"&F Allowance

1/10/2019

Matrix-FI

Contractor Name:	Part B	Exhibit 2
Contractor Number:
Period Ending :	December 31, 2010

400.14 - Exhibit 14 - Protocol for Estimating Allowance for Uncollectible Accounts

Fiscal Intermediary - Group 1

Allowance for Uncollectible Accounts Matrix
Part A (HI)
	Col. A	Col. B	Col. C	Col. D	Col. E
Sub-Group 1 (Non-Medicare Secondary Payer [MSP]) Cost Report Settlements, Claims Accounts Receivable Reconciliation (A/R), Credit Balance & Other Accounts Receivable	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
NONMSP	n/a	$ - 0	$ - 0	$ - 0	$ 165,436

Morgan: CMS:

This cell(F12) use to is referenced to the Delinquencies Exceeding 180 Days in the Allowance Tab (cell I69) in old version. It now references cell I83 on Allowance tab in new version, because the estimated allowance amount could potentially be determined based on the Collection percentage. Row 83 applies the comparison between the available methods and should therefore flow to the Matrix.

Total $ - 0 $ - 0 $ - 0 $ - 0 $ 165,436

Sub-Group 2 (MSP) Group Health Plan (Data-Match & Non-Data Match), Liability	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
MSP	n/a	$ - 0	$ - 0	$ - 0	$ 41

Total $ - 0 $ - 0 $ - 0 $ - 0 $ 41

	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
Sub-Group 1 (Non-MSP) Cost Report Settlements, Claims A/R, Credit Balance & Other Accounts Receivable	n/a	$ - 0	$ - 0	$ - 0

Morgan: CMS:

This cell(E22) was mapped to B22 in old version, but changed to E12 in the new version.	$ 165,436
	Sub-Group 2 (MSP) Group Health Plan (Data-Match & Non-Data Match), Liability	n/a	$ - 0	$ - 0	$ - 0

Morgan: CMS:

This cell(E23) was mapped to B23 in old version, but changed to E17 in the new version. $ 41

Total Part A (Hospital Insurance [HI]) $ - 0 $ - 0 $ - 0 $ - 0 $ 165,477

Part B/A (Supplementary Medical Insurance [SMI])
	Col. A	Col. B	Col. C	Col. D	Col. E
Sub-Group 1 (Non-MSP) Cost Report Settlements, Claims A/R, Credit Balance & Other Accounts Receivable	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
NONMSP	$ 881,162	$ - 0	$ 2,750,314	$ 2,750,314	$ - 0

Total $ 881,162 $ - 0 $ 2,750,314 $ 2,750,314 $ - 0

Sub-Group 2 (MSP) Group Health Plan (Data-Match & Non-Data Match), Liability	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
MSP	$ - 0	$ - 0	$ 71	$ 71	$ - 0

Total $ - 0 $ - 0 $ 71 $ 71 $ - 0

	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
Sub-Group 1 (Non-MSP) Cost Report Settlements, Claims A/R, Credit Balance & Other Accounts Receivable	$ 881,162	$ - 0	$ 2,750,314	$ 2,750,314

Morgan: CMS:

This cell(E41) was mapped to D41 in old version, but changed to E31 in the new version.

Sub-Group 2 (MSP) Group Health Plan (Data-Match & Non-Data Match), Liability $ - 0 $ - 0 $ 71 $ 71 Morgan: CMS:

This cell(E42) was mapped to D42 in old version, but changed to E36 in the new version.

Total Part B/A (SMI) $ 881,162 $ - 0 $ 2,750,385 $ 2,750,385 $ - 0

&"Arial,Bold"RFP # 75FCMC19R0023 &"Arial,Bold"&F Matrix-FI

1/10/2019

Matrix-Carrier

Contractor Name:	Part B	Exhibit 3
Contractor Number:
Period Ending :	December 31, 2010

400.14 - Exhibit 14 - Protocol for Estimating Allowance for Uncollectible Accounts

Carrier - Group 2

Allowance for Uncollectible Accounts Matrix
Part B (SMI)
	Col. A	Col. B	Col. C	Col. D	Col. E
Sub-Group1 (Non-Medicare Secondary Payer [MSP]) Claims Accounts Receivable Reconciliation (A/R), Credit Balance & Other Accounts Receivable

Emily Norment: Emily Norment:

Not sure what A/R stands for.	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
	NONMSP	$ 881,162	$ - 0	$ 2,750,314	$ 2,750,314	$ 165,436

Morgan: CMS:

This Cell(F12) in the old version referenced to the Delinquencies Exceeding 180 Days in the Allowance Tab (cell I69). This was changed to reference cell I83, because the estimated allowance amount could potentially be determined based on the Collection percentage. Row I83 applies the comparison between the available methods and should therefore flow to the Matrix.

Total $ 881,162 $ - 0 $ 2,750,314 $ 2,750,314 $ 165,436

Sub-Group 2 (MSP) Group Health Plan (Data-Match & Non-Data Match), Liability	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
MSP	$ - 0	$ - 0	$ 71	$ 71	$ 41

Total $ - 0 $ - 0 $ 71 $ 71 $ 41

	Historical Collection % Total	Individual Account Analysis	Delinquencies Exceeding 180 days total	Estimated Allowance for Uncollectible A/R	Estimated Allowance for Uncollectible A/R (Interest Only)	Justification for amount recorded on Summary 2 Trial Balance
Sub-Group 1 (Non-MSP) Claims A/R, Credit Balance & Other Accounts Receivable	$ 881,162	$ - 0	$ 2,750,314	$ 2,750,314

Morgan: CMS:

This cell(E22) was mapped to D22 in old version, but changed to E12 in the new version to be consistent with Matrix-FI tab.

Emily Norment: Emily Norment:

Not sure what A/R stands for.					$ 165,436
	Sub-Group 2 (MSP) Group Health Plan (Data-Match & Non-Data Match), Liability	$ - 0	$ - 0	$ 71	$ 71

Morgan: CMS:

This Cell(E23) was mapped to D23 in old version but changed to E17 in new version to be consistent with Matrix-FI tab. $ 41

Total Part B (Supplementary Medical Insurance [SMI]) $ 881,162 $ - 0 $ 2,750,385 $ 2,750,385 $ 165,477

&"Arial,Bold"RFP # 75FCMC19R0023 &"Arial,Bold"&F Matrix-Carrier

1/10/2019

Data

TROR_Line	NONFEDERAL-GEN-MSP-CM-Registers-TOTAL	NONFEDERAL-GEN-NONMSP-CM-Registers-TOTAL	NONFEDERAL-NA-NA-CM-Registers-TOTAL	NONFEDERAL-NA-NA-CM-TROR-COUNT	NONFEDERAL-NA-NA-CM-TROR-TOTAL	NONFEDERAL-SMI-MSP-CM-Registers-TOTAL	NONFEDERAL-SMI-NONMSP-CM-Registers-TOTAL
(1) Beginning FY Balance	39	156949		30999	7628738	71	7471680
(2) New Receivables (+)				142633	12715571		12715571
(3) Accruals (+) (New Interest Receivables)					180188
(4) Collections on Receivables (-)					-10857069
(5) Adjustments				5489	-170865
(6) Amounts Written-Off (-)				27374	-1108768
(7) Ending Balance (TROR/Activity Registers)				42302	8387795
(A) At Agency		-43429			-10650198		-10606769
(A) Currently Not Collectible (-)		-71117		573	-905070		-833953
(A) Reclassified/Adjusted Amounts (+ or -)		-612			-539383		-538772
(B) Written-Off and Closed Out (-)		-664		26801	-203697		-203033
(D) Collections by Treasury through Offset and Cross-Servicing (-)	-121	-27182			-206870	-263	-179305
(E) Written-Off Debts Reinstated for Collections (+)	121	19040			368518	263	349095
Beneficiary			44583				44583
Beneficiary[180]			524				524
CMS Adjustment Register (support line 3)	2	123951
GHP(Data/non-Data Match)	41		112			71
GHP(Data/non-Data Match)[180]	41		112			71
Physician/Supplier		213169	8343100				8129931
Physician/Supplier[180]		165436	2915225				2749790
Transaction Register (support line 3)		56235

Changes to Calcs

Tab	Cell Changed	Changed From	Changed to	Change Rationale
Matrix-Carrier	F22	D22	E12	"Estimated Allowance for Uncollectible Accounts Receivable Reconciliation (A/R)" should be most conservative estimate of "Delinquencies Exceeding 180 days total" or "Historical Collection % Total".
Matrix-Carrier	E23	D23	E17	"Estimated Allowance for Uncollectible A/R" should be most conservative estimate of "Delinquencies Exceeding 180 days total" or "Historical Collection % Total".
Matrix-Carrier	F12	Allowance!I69	Allowance!I83	Cell F12 - Estimated Allowance for Uncollectible A/R (Interest Only) – this is referenced to the Delinquencies Exceeding 180 Days in the Allowance Tab (cell I69). This should be referenced into cell I83, because the estimated allowance amount could potentially be determined based on the Collection percentage. Row 83 applies the comparison between the available methods and should therefore flow to the Matrix.
Matrix-FI	E22	D22	E12	"Estimated Allowance for Uncollectible A/R" should be most conservative estimate of "Delinquencies Exceeding 180 days total", "Individual Account Analysis" or "Historical Collection % Total".
Matrix-FI	E23	D22	E17	"Estimated Allowance for Uncollectible A/R" should be most conservative estimate of "Delinquencies Exceeding 180 days total", "Individual Account Analysis" or "Historical Collection % Total".
Matrix-FI	E41	D41	E31	"Estimated Allowance for Uncollectible A/R" should be most conservative estimate of "Delinquencies Exceeding 180 days total", "Individual Account Analysis" or "Historical Collection % Total".
Matrix-FI	E42	D42	E36	"Estimated Allowance for Uncollectible A/R" should be most conservative estimate of "Delinquencies Exceeding 180 days total", "Individual Account Analysis" or "Historical Collection % Total".
Matrix-Carrier	F12	Allowance!I69	Allowance!I83	Cell F12 - Estimated Allowance for Uncollectible A/R (Interest Only) – this is referenced to the Delinquencies Exceeding 180 Days in the Allowance Tab (cell I69). This should be referenced into cell I83, because the estimated allowance amount could potentially be determined based on the Collection percentage. Row 83 applies the comparison between the available methods and should therefore flow to the Matrix.

&"Arial,Bold"RFP # 75FCMC19R0023 &"Arial,Bold"&F Changes to Calcs

1/10/2019

Request_IDs

Original Workload	Cust_Class	Report	12/31/2010
99998	NONFEDERAL	AdjLn3rpt	11337101
99998	NONFEDERAL	AdjLn5_6rpt	11359879
99998	NONFEDERAL	AppCollrpt	11337102
99998	NONFEDERAL	AROvrrpt	11337104
99998	NONFEDERAL	AROvrrpt[180]	11324610
99998	NONFEDERAL	BBrpt	11337098
99998	NONFEDERAL	HIGLAS_TROR	11341019
99998	NONFEDERAL	TALn2rpt	11337099
99998	NONFEDERAL	TALn3rpt	11337100

&"Arial,Bold"RFP # 75FCMC19R0023 &"Arial,Bold"&F Request IDs

1/10/2019 Page &P

Lookup_Values

Category	ORG NAME
CM	12/31/2010
ORG	Part B
Part	B
PM	11/30/2010
PQ	9/30/2010
PY	12/31/2009
WL	99998

HISTORICAL_ALLOWANCES

HISTORICAL_YEAR	NONFEDERAL-HI-MSP-CM-Registers-TOTAL	NONFEDERAL-HI-NONMSP-CM-Registers-TOTAL	NONFEDERAL-SMI-MSP-CM-Registers-TOTAL	NONFEDERAL-SMI-NONMSP-CM-Registers-TOTAL
2010			0.2	0.15
2009			0.1	0.12
2008			0.14	0.1

File details come from the government source that posted it. Updated Dec 28, 2023.