Appendix%207.17%20ASP%20Reconciliation%20Template.xlsx

This is an ASP (Average Selling Price) Reconciliation Template appendix document related to Third Party Administrator Services for Tennessee's Public Sector Health Plans. The template is designed to facilitate the reconciliation of pharmaceutical claims at the claim level detail, capturing comprehensive data across medical specialty pharmacy transactions. The template requires documentation of provider information, including provider type and tax identification numbers, along with claim adjudication details such as date of adjudication and HCPC codes with corresponding procedure descriptions.

The reconciliation template captures critical pricing and utilization data elements including NDC numbers, drug strength descriptions, NDC package sizes, allowed units, billed units, and updated units. It tracks allowed charges against ASP (Average Selling Price) on the date of adjudication and calculates total ASP-based charges based on date of service and updated units, with provisions for ASP plus a percentage markup calculation. This template serves as the operational mechanism for ensuring accurate pharmaceutical claim reconciliation and pricing verification within the state's health plan administration framework, with all pricing information subject to Cigna's confidentiality protections.