PDA offers our clients the most extensive and effective ongoing RDS services available in the RDS administration marketplace. We handle every possible aspect of the program for Plan Sponsors, including, but not limited to, setting up new applications, managing and regular updates to eligibility records, aggregating monthly data and filing cost reports, compiling rebate data, completing reconciliations, and warehousing all data for the six year term required by the Centers for Medicare and Medicaid Services (CMS).
Our approach allows the Plan Sponsor to remain in the driver’s seat of the RDS process without the hassle of the day to day activities, saving their staff time and money. Additionally, our solution is extremely customizable and allows us to provide a variety of reporting and communication options to keep you updated on all changes and current work projects.
PDA’s clients benefit from our one of a kind claim data processing and from our expert eligibility management system, proprietary drug filtering software and one-of-a-kind new member identification algorithm, which allows Plan Sponsors to maximize their subsidy dollars from every aspect of the RDS program. A full list of our ongoing RDS services can be found below. A printable version is located on our Documents pages.
Identify all Unique Benefit Options (UBOIs) within a Group Health Plan (GHP)
Regular Eligibility Updates
Coordinate Monthly Individual Eligibility & Claims Data
Monitor Eligibility & Claim Data for Final Reconciliation
Receive & Incorporate CMS’ Weekly Eligibility Updates
Be Designated at Account Manager (AM)
Register as a Payment Requester (PR) Designee
Complete Sections 1-3 & 5-7 & 9 of Application
Actuary Completes Section 5 of Application
Receive and Review Monthly Claim Information
Adjust Claims for Estimated Rebates
Calculate Aggregate Subsidy Amount for all RMEIs
Compile Final Rebate Data
Finalize Reconciliation Payment Request
Draft & Mail Annual CMS Creditable Coverage Notices to Eligible Individuals
All Application Materials & Payment Requests