Dispute Reminder
As a reminder, after submitting a Dispute Submission file, check the Dispute Submission Tab on the CGDP Portal for the status of the file submission. When submitting a Dispute File, The TPA recommends that submission of dispute files occur as soon as you identify dispute-eligible invoice line items and not wait until the dispute submission deadline. Submitting dispute files a week or more before the submission deadline allows you to correct errors if the submitted file receives a failed status and the corrected records can be re-submitted before the submission deadline. Be sure to check the CGDP Portal again after a failed status has been corrected and re-submitted.
Dispute Submission files are edited twice. The TPA performs file level edits and some line item edits, and then CMS performs all of the data level edits. Validation edit processing must complete and dispute files must receive both a TPA Passed and a CMS Accepted status before they are eligible for CMS review and analysis. A list of the Dispute Edits is located on the Third Party Administrator website under the Manufacturer Disputes link. Again, please allow yourself enough time to correct a failed or rejected Dispute Submission file and re-submit before the submission deadline for rejected or failed error types. Dispute Submissions are updated on the CGDP Portal daily. If you do not receive a response within one business day on the Portal, please contact the TPA.
Disputes passing TPA file level edits are sent on to CMS for further editing. A Dispute Return Report from the CMS edits will show if the Disputes were “Accepted” or “Rejected”. The Return Report will be available on the Disputes Tab of the CGDP Portal the next business day for “Passed” Dispute files submitted before 3:45PM Eastern time. Again, please allow yourself enough time to correct a ‘Rejected” Dispute Return Report records and re-submit the corrected records before the submission deadline.
If you have any questions, please contact the TPA at 1-877-534-2772, option 1 or by email at tpaoperations@tpadministrator.com.