Manufacturer Dispute Submission and Attachment Overview
GENERAL INFORMATION
Manufacturers create a Dispute Submission File by using the information provided in the Data report for the current reporting period. Manufacturers will access the Data report on the CGDP Portal by Corporate ID under the CGDP Reports Tab and populate the Data radio button. The population of the Data radio button provides a user with reports containing summary information of the PDE’s combined to create the total invoice line item amount distributed to the Manufacturer.
According to the terms in the Manufacturers’ Agreement, Part D Manufacturers will have 60 calendar days from the date of Invoice Receipt to submit a dispute file. Manufacturers Agreement Section II (b): Receipt of the invoice shall be considered to be one (1) calendar day after the TPA electronically transmits the invoice to the Manufacturer or otherwise notifies the Manufacturer that it is available (e.g., it is posted on a secure web site for download).
Note: Only disputed records should be included in the dispute file. Dispute files can only contain data for a single P number. Files containing multiple P numbers for a Corporate ID will error out in the Portal.
HOW TO CREATE A DISPUTE SUBMISSION FILE
Manufacturers are now able to create and submit disputes via the CGDP Portal by utilizing the Dispute Builder functionality to create dispute files, or continue to create manual dispute files. Both of which use current reporting period information located in the Data report.
The Dispute Builder Tab on the CGDP Portal tab allows a user to create dispute files from the Data report files from the current reporting period. This functionality will aid users in creating dispute files that pass the TPA and CMS edits in a timely manner. Instructions for creating, completing, and submitting a dispute file using the Dispute Builder functionality are located under the Creating Dispute Files via the Dispute Builder functionality and Submitting Dispute Builder Dispute File instructions in the Manufacturer Users Guide.
For manual dispute file creation and conversion, information located in the Data report is required for input into the Dispute Submission File. The following steps outline this conversion:
- Change File ID from 10MDT to 10DSP in Field 6 of the Manufacturer Header Record (TPAMH).
- Add the Invoice Received Date (one day after the Invoice Distribution Date) to Manufacturer Header Record (TPAMH), Field 8.
- Add the TPA Dispute Received Date to Manufacturer Header Record (TPAMH), Field 9.
- Add the Dispute Reason Code to Field 19 of the Detail Record (DETCG).
- Add the Support Detail Reference Number to Field 20 of the Detail Record (DETCG).
- Add the Support Date 1 to Field 21 of the Detail Record (DETCG).
- Add the Support Date 2 to Field 22 of the Detail Record (DETCG).
- Add Additional Information (when required) to Field 23 of the Detail Record (DETCG).
- Change File ID from 10MDT to 10DSP in Field 6 of the Manufacturer Trailer Record (TPAMT).
- Save the file as a text file.
You can use a text editor like Wordpad, Notepad, or Textpad to create and save the file. Instructions for uploading and submitting a manual dispute file are located in the Submitting Manual Dispute Files instructions in the Manufacturer Users Guide. Once the text file is loaded to the CGDP Portal, the editing process begins by the TPA and CMS.
Note: Only disputed records should be included in a dispute file. Dispute files can only contain data for a single P number. Files containing multiple P numbers for a Corporate ID will error out in the Portal.
HOW TO CREATE A DISPUTE ATTACHMENT
Prepare the Dispute Submission file according to the instructions referenced in the Manufacturers User Guide and those provided in the section above - How to Create a Dispute Submission File.
Note: Submit dispute attachments once your disputes have received a status of “Accepted” on the CGDP Portal Disputes Tab.
Prepare supporting documents by including your P number, invoice reporting period, dispute reason code and Detail Reference Number, if applicable, of the item(s) you are disputing on the top of each page of your attachment. If one document represents more than one disputed invoice payment, send the document only once but note all applicable dispute line items associated with the document on the top of each page and if necessary continued in the body of the email.
Convert the document(s) to electronic files in *PDF format. Contact the TPA if you have questions about creating PDF files.
Attach dispute documentation to an email with the P number, invoice reporting period and dispute reason code of the dispute(s) in the subject line. Do not attach more than 20mb of data, singly or in combination, to one email. Emails exceeding 20mb attachments may be rejected by the TPA’s email system and you may not receive notification if this happens.
Send the email to disputes@tpadministrator.com. Successful receipt of the email and attachment will generate an acknowledgement email. If you do not receive an acknowledgement reply within 24 hours, contact the TPA. The TPA and CMS will not be responsible for submission deadlines missed due to rejected or unprocessed email.
*Please note: There are many free and low cost programs available to create PDF files. Microsoft Office has an add-in to create a PDF file that is available to download on their web site. Many freeware and shareware programs are available to convert most file types to PDF. Some examples are PrimoPDF, Solid PDF Creator, Free HTML to PDF Converter, doPDF Free Converter, PDF24 Creator, CutePDF Writer, Go2PDF, FreePDF Creator, and http://www.pdfonline.com/convert-pdf/. The TPA lists these programs as a convenience to the Manufacturers, who are solely responsible for any risk assumed from downloaded software.
If you have any questions, please contact the TPA at 1-877-534-2772, option 1 or by email at tpaoperations@tpadministrator.com.