Completing the Certification Form

190.1 - Completing the Certification Form (Rev. 149; Issued: 03-27-0; Effective Date: Upon the start of the contractor’s next option year; Implementation Date: 04-27-09) A. General There are four sections that are utilized by the user to generate the PM certification. They are: Credit, Activity Summary by Function, Administrative Funds Drawn and Certification Screen. For MIP, there are three sections. They are: Activity Summary by Function, Administrative Funds Drawn and Certification Screen. For PM, the user will enter the COB credits. After the user has entered all COB credit information, the system will sum the data to a "face sheet" amount by Medicare function, for Total Cost and Total Adjusted Cost, including a separate line for COB credits. The contractor will attest to the accuracy of the data included in the report by completing a certification statement. B. Uses The form will be used for the BR, SBR, IER, and FACP. C. Completing the Certification Section 1. Credit Amount The contractor shall enter the separate cumulative amounts of cash received for Complementary Credit and Medicaid to equal total credits. The user must also enter the separate amounts of accrued credits in total. Accrued credits represent outstanding receivables (invoices that have been billed but payments have not been received as of report date). This section must be completed prior to generation of the Certification Section. The complementary credits shall be reported in the following manner: Complementary Credit – Not applicable unless the Medicare contractor receives late payment for a transitioned COBA trading partner. Medigap – the contractor shall report all complementary credits received from trading partners as a result of crossing over claim-based Medigap claims to trading partners. An agreement may be in place for transmission purposes. COB Credits – the contractor shall report only the cash received from the COBC for claims crossed over in COBA production. Accrued Credits – the contractor shall report all receivables due from trading partners that the contractor invoiced for themselves. Accrued COB Credits – the contractor shall report all receivables due from the COBC for claims transmitted to the COBC for crossover in COBA production (adjusted by reimbursement, error reports, including accepted trading partner disputes that were returned to the contractors, and other adjustments reported on the contractor remittance advice). 2. Activity Summary By Function Section This is a system-generated area. The system will sum the data to a total face sheet by Medicare function. No input is required by the user; however, the total must tie to subsidiary records. 3. Administrative Funds Drawn Section This section is completed only for the IER. (See Chapter 2, section 60.6.) 4. Certification Section The contractor shall enter name of Certifying Official and Title. An authorized official signs and dates the hard copy report and retains a copy in file. 5. Remarks Section The contractor shall complete this section when appropriate. Medicare Administrative Contractors and Durable Medical Equipment Medicare Administrative Contractors ONLY A. General Contractors shall report all workloads, net errors reported to them by COBC via the shared system for crossover claims to their respective project officers. Cash received from the COBC shall be recorded in the Analysis Reporting and Tracking System (ARTs) monthly. Contractors shall utilize cash base accounting methodology to validate the COBC’s complementary credit data effective with the start of contractor new option year.