Transmittal 158 Date: September 25, SUBJECT: Revised Bank Account Analysis Procedure and Letter-of-Credit List

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1 anual ystem Pub edicare inancial anagement Department f ealth & uman ervices (D) enters fr edicare & edicaid ervices () Transmittal 158 Date: eptember 25, 2009 hange equest 6644 UBJT: evised Bank ccunt nalysis Prcedure and Letter-f-redit List. UY O NG: The new requirement is fr all edicare ntractrs (nn-gl and GL) t prepare the mnthly chedule f temized Bank ervices Prvided eprt and the ecap f Daily vailable Balances schedules in xcel (see attached) and frward them t Banking2009@cms.hhs.gv by the 15th f each mnth. NW / VD TL TV DT: *Octber 26, 2009 PLNTTON DT: Octber 26, 2009 Disclaimer fr manual changes nly: The revisin date and transmittal number apply nly t red italicized material. ny ther material was previusly published and remains unchanged. wever, if this revisin cntains a table f cntents, yu will receive the new/revised infrmatin nly, and nt the entire table f cntents.. NG N NUL NTUTON: (N/ if manual is nt updated) =VD, N=NW, D=DLTD-Only One Per w. /N/D hapter / ectin / ubsectin / Title 5/100/110.2/Bank ccunt nalysis 5/150/Letter-Of-redit heck List. UNDNG: TON : r iscal ntermediaries and arriers: N additinal funding will be prvided by ; ntractr activities are t be carried ut within their perating budgets. TON B: r edicare dministrative ntractrs (s): The edicare dministrative ntractr is hereby advised that this cnstitutes technical directin as defined in yur cntract. des nt cnstrue this as a change t the tatement f Wrk. The cntractr is nt bligated t incur csts in excess f the amunts alltted in yur cntract unless and until specifically authrized by the ntracting Officer. f the cntractr cnsiders anything prvided, as described abve, t be utside the current scpe f wrk, the cntractr shall withhld perfrmance n the part(s) in questin and immediately ntify the ntracting Officer, in writing r by , and request frmal directins regarding cntinued perfrmance requirements. V. TTNT: Business equirements anual nstructin *Unless therwise specified, the effective date is the date f service.

2 ttachment - Business equirements Pub Transmittal: 158 Date: eptember 25, 2009 hange equest: 6644 UBJT: evised Bank ccunt nalysis Prcedure and Letter-f-redit List TV DT: Octber 26, 2009 PLNTTON DT: Octber 26, GNL NOTON. Backgrund: s f January 1, 2009, the enters fr edicare and edicaid ervices () made a decisin t eliminate the use f time accunts as a funding mechanism t pay fr cmmercial bank service charges. s a result, the reprting f the T (Quarterly djustment f ederal health nsurance Time ccunt), T-1a (ummary f Bank Prcessing charges fr Quarter), T-1b (Banking Prcessing harges) and T-1c schedules ( list f daily clsing bank balances) are being eliminated. We are n lnger requiring nn-gl edicare cntractrs t reprt the abve mentined schedules in. B. Plicy: The is requiring all edicare cntractrs (nn-gl and GL) t submit the attached xcel spreadsheet schedules (1. chedule f temized Bank ervices Prvided eprt and 2. ecap f Daily vailable Balances) t. The schedules are required t be sent t Banking2009@cms.hhs.gv; by the 15 th f each mnth.. BUN QUNT TBL Use hall" t dente a mandatry requirement Number equirement espnsibility (place an X in each applicable clumn) / B D hared- ystem aintainers OT ntractr shall adhere t the fllwing prcedures: rrange t receive frm the bank its accunt analysis n a regular mnthly basis n later than the 10th f the fllwing mnth. Bank analysis must include: Bank Prcessing harges (chedule f temized Bank ervices Prvided eprt); and list f daily clsing bank balances X X X X X V W

3 Number equirement espnsibility (place an X in each applicable clumn) / B D hared- ystem aintainers OT (ecap f Daily vailable Balances). V W ntractr shall cmplete and frward, within 15 calendar days after the end f each mnth t electrnically (xcel; Banking2009@cms.hhs.gv), the fllwing schedules: X X X X X nthly accunt activity f bank prcessing charges (chedule f temized Bank ervices Prvided eprt); and ecap f Daily vailable Balances (ecap f Daily vailable Balances).. POVD DUTON TBL Number equirement espnsibility (place an X in each applicable clumn) / B D hared- ystem aintainers OT Nne V W V. UPPOTNG NOTON ectin : r any recmmendatins and supprting infrmatin assciated with listed requirements, use the bx belw: Use "huld" t dente a recmmendatin. X-ef equireme nt Number ecmmendatins r ther supprting infrmatin: Nne

4 ectin B: r all ther recmmendatins and supprting infrmatin, use this space: V. ONTT Pre-mplementatin ntact(s): azel L. Jhnsn, azel.jhnsn@cms.hhs.gv, (410) Wayne laughter, Wayne.laughter@cms.hhs.gv, (410) Pst-mplementatin ntact(s): azel L. Jhnsn, azel.jhnsn@cms.hhs.gv, (410) Wayne laughter, Wayne.laughter@cms.hhs.gv, (410) V. UNDNG ectin : r iscal ntermediaries (s), eginal me ealth ntermediaries (s), and/r arriers: N additinal funding will be prvided by ; cntractr activities are t be carried ut within their perating budgets. ectin B: r edicare dministrative ntractrs (s): The edicare dministrative ntractr is hereby advised that this cnstitutes technical directin as defined in yur cntract. des nt cnstrue this as a change t the tatement f Wrk. The cntractr is nt bligated t incur csts in excess f the amunts alltted in yur cntract unless and until specifically authrized by the ntracting Officer. f the cntractr cnsiders anything prvided, as described abve, t be utside the current scpe f wrk, the cntractr shall withhld perfrmance n the part(s) in questin and immediately ntify the ntracting Officer, in writing r by , and request frmal directins regarding cntinued perfrmance requirements. TTNT

5 ntractr's Name (Number) Bank's Name Date nthly chedule f temized Bank ervices Prvided eprt Nte: The cntractr shall: 1.) add/delete any line items that are applicable/nn-applicable. 2.) use the same terminlgy as their bank. easured ccunt ervices Vlume Price st Bank Trancde Nte/Descriptins/nfrmatin urces 1 PYNT VOU 0.00 a) Wire Transfer dvices TOP PYNT OD (nthly aintenance) N a) On Line equests 0.00 b) anual/vice equests 0.00 c) utmatic enewals N 3 OUNT NTNN DPOT: a) # f Depsit Tickets 0.00 b) # f Depsited tems 0.00 c) # eturned Depsited tems K PONG a) # f hecks Debited 0.00 b) Data Transmissin - Paid tems 0.00 c) ecnciliatin ee 0.00 d) heck rting (inimum $50) 0.00 e) heck icrfilming (inimum $30) N f) ntrlled Disbursement aintenance 0.00 g) dditinal ecns T/ PO (nthly aintenance) 0.00 a) Debit/redit ntries 0.00 b) Prentes 0.00 c) Data Transmissin - Transactins 0.00 d) eturns/no 0.00 e) eversals & Deletins 0.00 f) ddenda ecrds 0.00 g) Debit uthrizatin-ccunt aintenance 0.00 h) Debit uthrizatin-eturn tems 0.00 ) Debit uthricatin-etup ee Per ccunt OT V: a) nfrmatin eprting 0.00 b) edicare eprting 0.00 c) pecial tatement ervices d) icrfiche Pages - ecn eprts N e) heck Phtcpies 0.00 f) heck ejects > 2% 0.00 g) heck mage aintenance N h) heck mage apture 0.00 ) mage nquiry aintenance N j) mage etrieval tems 0.00 k) D O Disks 0.00 l) D O Disk ecreatin 0.00 m) Psitive Pay aintenance 0.00 n) Psitive Pay-Payee Name Verificatin 0.00 ) Psitive Pay xceptins tems 0.00 p) Psitive Pay eturns 0.00 q) Psitive Pay ax/day 0.00 r) Depsit Ticket Orders 0.00 s) Outging Wires - anual epetitive 0.00 t) ncming Wires 0.00 u) Prir Perid djustment N v) ntractr reated Overdraft - alculated using the arnings ates N w) Psitive Pay-Payee Name Verificatin 0.00 x) Zer Balance aintenance Per Parent ccunt 0.00 y) emte Depsit apture-nthly aint 0.00 z) emte Depsit apture-tickets 0.00 aa) emte Depsit apture tems Depsited 0.00 ab) emte Depsit eturns (if they ccur) 0.00 ac) emte Depsit djustments (if they ccur) 0.00 ad) emte Depsit canner st 0.00 Ttal easured ervices Printed 09/24/2009

6 ntractr's Name (Number) Bank's Name Date P O DLY VLBL BLN DT BLN DT BLN um t vg. Daily Balance fr nth: $0.00 alculatin f vg. Daily Balance during each Prime ate perid #DV/0! Bank ates rm Number f Days um f Ttal Balances Balance # $0.00 #VLU! Printed 09/24/2009

7 Bank ccunt nalysis (ev.158, ssued: , ffective: , mplementatin: ) T ensure a cntinuing evaluatin f all bank services and assciated charges, the cntractr shall adhere t the fllwing prcedures: rrange t receive frm the bank its accunt analysis n a regular mnthly basis n later than the 10th f the fllwing mnth. Bank analysis must include: Bank Prcessing harges (chedule f temized Bank ervices Prvided eprt); and list f daily clsing bank balances (ecap f Daily vailable Balances). The cntractr shall verify the accuracy f the data presented fr the average daily bank balance, units f service, and all ther cmputatins n the bank's accunt analysis. The cntractr shall cmplete and frward, within 15 calendar days after the end f each mnth t electrnically (xcel; Banking2009@cms.hhs.gv;), the fllwing schedules: nthly accunt activity f bank prcessing charges (chedule f temized Bank ervices Prvided eprt); and ecap f Daily vailable Balances (ecap f Daily vailable Balances) Letter-Of-redit heck List (ev.158, ssued: , ffective: , mplementatin: ) O N DU DT ntermediary Benefit Payment eprt, Payment vucher n Letter-f-redit Transmittal nthly ntermediary inancial eprt, nthly - within 20 wrking days after the end f the reprting mnth. nthly - within 15 days after the end f the reprting mnth. ame as abve Banking chedules, chedule f temized Bank ervices Prvided eprt and ecap f Daily vailable Balances nthly - within 15 days after the end f the reprting mnth

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