Exhibit_29_Premium_Discrepancy_Reports.xlsx
XLSX spreadsheet 30 KB Posted
- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
This document is an Exhibit 29 Premium Discrepancy Reports template for the OEIBA (Oklahoma Employees Insurance and Benefits Act) Program, designed for tracking premium discrepancies for Medicare Advantage Prescription Drug (MAPD) and Health Maintenance Organization/Medicare Supplement (HMO/MSP) plans. The exhibit specifies two reporting templates with distinct submission requirements: MAPD premium discrepancy reports are due 30 days after premium remittance, while HMO/MSP premium discrepancy reports are due 60 days after premium remittance. Both reports must be electronically submitted to EGID-General_Ledger_Unit@omes.ok.gov using a secure email domain.
The reporting templates require detailed documentation of premium discrepancies, including member identification, last name, first name, discrepancy amount, and supplier comments. The reports are designed to highlight any differences between premium remittance and eligibility records for MAPD and HMO/MSP plans. Suppliers are instructed to submit the completed template as an Excel file, with no additional security measures required when using the specified secure email domain. The standardized format ensures consistent and comprehensive tracking of premium discrepancies across different insurance plan types.
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Text version
Report Cover
| Exhibit 29: Premium Discrepancy Reports |
| [Supplier Name] |
| OEIBA Program |
| [Date] |
| Report | Report Title | Tab Name |
| 29a | MAPD Premium Discrepancy | MAPD Premium |
| 29b | HMO/MSP Premium Discrepancy | HMO.MSP Premium |
| Notes: |
| 1) Reports should be sent electronically by a secure email domain to: EGID-General_Ledger_Unit@omes.ok.gov |
| 2) Completed template must be submitted electronically as an Excel file. No additional security is necessary when a Supplier emails reports using the secure email domain. |
29a MAPD Premium Due Date 30 days after the premium remittance
| MAPD Premium Discrepancy |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| Discrepancy | Member ID | Last Name | First Name | Amount of premium discrepancy | Supplier comments |
| 1 | |||||
| 2 | |||||
| 3 | |||||
| 4 | |||||
| 5 |
*Showing any discrepancy between the premium remittance and the MAPD's eligibility records
29b HMO.MSP Premium Due Date 60 days after the premium remittance
| HMO/MSP Premium Discrepancy |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| Discrepancy | Member ID | Last Name | First Name | Amount of premium discrepancy | Supplier comments |
| 1 | |||||
| 2 | |||||
| 3 | |||||
| 4 | |||||
| 5 |
*Showing any discrepancy between the premium remittance and the HMO/MSP eligibility records
File details come from the government source that posted it. Updated .