Federally-Facilitated Marketplace (Ffm) User Fee Adjustment Web Form Quick Startguide - Centers For Medicare And Medicaid Services Page 12
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19FFM User Fee Adjustment Web Form Quick Start Guide
Step
Action
6
In the FFM User Fee table, enter the amount of total contraceptive claims paid
by the TPA or PBM.
Repeat steps 5-7 for each row added.
7
Select the Calculate button.
This will populate the Totals row:
Column/Row
Calculation
Totals
Sum of all amount fields for number of
participants and beneficiaries in self-insured plan
administered by the TPA or PBM and amount of
total contraceptive claims paid by the TPA or
PBM.
8
Select the Continue button.
You will be directed to the Summary page of the web form.
To delete a row, select the Delete link next to the self-insured
plan Tax Identification Number you would like to delete. To add a row,
select the Add Row button above the FFM User Fee table. To delete
the entire table, select the Delete Table button above the FFM User Fee
table.
FFM User Fee Adjustment Web Form Quick Start Guide
12
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