Senior Specialist 401k Recordkeeping T Bank N.A.
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Greenline Wealth Management
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Pollard & Associates
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Defined Contribution Account Manager Nova 401(k) Associates
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Fringe Benefit Group
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Defined Contributions Compliance Consultant Loren D. Stark Company (LDSCO)
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Retirement Solutions Specialists
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Defined Benefit Combo Cash Balance Compliance Consultant Loren D. Stark Company (LDSCO)
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Retirement Planners and Administrators (RPA)
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New York City District Council of Carpenters Benefit Funds
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Great Lakes Pension Associates, Inc.
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TPA Retirement Plan Consultant EPIC RPS (TPA/DPS)
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Defined Benefit Consultant/Enrolled Actuary Pension Plan Specialists, PC
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Text of CMS Guidance for Issuers of Qualified Health Plans: Re-Adjudication of Claims Subject to Cost-Sharing Reductions (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] [Official Guidance] Nov. 18, 2014 "CMS expects issuers to re-adjudicate claims in a manner resulting in cost-sharing reduction calculations approximating the amounts that would result if the claims were re-adjudicated in the order in which the claims arose ... [To] ensure accuracy and consistency, an issuer that uses a third-party PBM for pharmaceutical claims may elect to re-adjudicate claims by first setting all accumulators to zero, and then reprocessing the medical claims in temporal order followed by the pharmaceutical claims in temporal order.... [This] guidance also applies with respect to any other third-party administrator of a subset of an issuer's benefits, such as a third-party administrator of substance use disorder benefits." |
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