Processes
Record and report CMS true-up
How record and report cms true-up are reshaped as AGI capability advances.
ProcessesRecord and report CMS true-up
Business-as-Code
Read as an executable program — the work decomposed into Code, Generative, Agentic, and Human.
Record and report CMS true-up sits inside a larger value-flow — 1 parent structure it composes into. The hierarchy is grounding, not the story: it tells you which aggregate exposure Record and report CMS true-up inherits.
Where Record and report CMS true-up sits
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How the work flows
Trigger: The close of the plan year or the receipt of preliminary settlement data from CMS initiates the reconciliation cycle.
- Aggregate annual claims and enrollment data
- Calculate estimated CMS risk and subsidy settlements
- Reconcile internal financial estimates with preliminary CMS reports
- Investigate and resolve membership or claims data variances
- Post financial true-up adjustments to the general ledger
- Transmit final true-up reports and attestations to CMS
Outcome: Final financial true-up adjustments are posted to the general ledger and formal reconciliation reports are accepted by CMS.
Measured by
Settlement Variance PercentageReconciliation Cycle TimeRegulatory Submission Compliance Rate