Year-End Reconciliation Process. 1. The Parties agree that year-end reconciliation, as defined in Attachment A, will be conducted in accordance with Section 9.5 of Attachment A of this Contract using all reports in Section 9.4 through and including 9.4.16 of Attachment A.
2. Before calculating any differences between the ETCOC and ATCOC, DVHA will retrospectively review attribution and Member eligibility for the Performance Year. DVHA will communicate proposed changes to Contractor and Contractor will have the opportunity to review and validate the proposed changes to the extent possible. In the event there are valid changes, DVHA will calculate any corresponding financial reconciliation of the ETCOC and Fixed Prospective Payment and present this reconciliation to Contractor. Contractor will have the opportunity to review the reconciliation for accuracy. After validation, the dollar amount of the reconciliation will be factored into the calculation to determine the final program settlement amount.
3. Prior to calculating any differences between the ETCOC and ATCOC, DVHA will remove from the calculation of the ATCOC the cost of Covered Services, determined by combining the fee-for-service payments and amounts that would have been paid to providers on Zero-Paid Claims, in excess of $500,000 for any individual Members after all other exclusion rules have been applied.
4. The aggregate difference between the ETCOC and ATCOC will be determined by subtracting the ATCOC from the ETCOC. By way of example, the calculations will be applied in the following order.
