Comprehensive Ongoing RDS Services.

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.

Activity

PDA

GHP

PBM

Overall Process

Submit or Review RDS Application

Checkmark

Identify all Unique Benefit Options (UBOIs) within a Group Health Plan (GHP)

Checkmark

Supply Data

Supply Data

Identify Retired Medicare Eligible Individuals (RMEIs)

Checkmark

Regular Eligibility Updates

Checkmark

Provide Actuary for Gross & Net Test Attestations

Checkmark

Obtain Eligibility & Claims Data

Checkmark

Coordinate Monthly Individual Eligibility & Claims Data

Checkmark

Supply Data

12 Month Eligibility & Claims Data for Final Reconciliation

Checkmark

Supply Data

Monitor Eligibility & Claim Data for Final Reconciliation

Checkmark

Monitor Application-Specific RDS Requirements & Deadlines

Checkmark

Receive & Incorporate CMS’ Weekly Eligibility Updates

Checkmark

RDS Website Account Setup & Maintenance

Register GHP & Plan Sponsor with RDS

Checkmark

Be Designated at Account Manager (AM)

Checkmark

Designate Authorized Representative (AR)

Checkmark

Designate Actuary

Checkmark

Register as a Cost Reporter (CR) Designee

Checkmark

Register as a Payment Requester (PR) Designee

Checkmark

Complete Payment Setup

Checkmark

Application Setup & Maintenance

Complete Sections 1-3 & 5-7 & 9 of Application

Checkmark

Upload Retiree Census Data to RDS Website

Checkmark

Actuary Completes Section 5 of Application

Checkmark

Review and Sign Section 9 of Application

Checkmark

Monthly Payment Request Process

Receive and Review Monthly Claim Information

Checkmark

Adjust Claims & Filter for Non-Part D Drugs

Checkmark

Adjust Claims for Estimated Rebates

Checkmark

Calculate Subsidy Amount for Each RMEI

Checkmark

Calculate Aggregate Subsidy Amount for all RMEIs

Checkmark

Handle RDS Denials, Inquires & Responses

Checkmark

Submit Monthly Subsidy Payment Request

Checkmark

Annual Reconciliation 12 Step Process

Finalize Covered Retirees List

Checkmark

Compile Final Rebate Data

Checkmark

Supply Data

Supply Data

Generate and Manage Final Cost Reports

Checkmark

Finalize Reconciliation Payment Request

Checkmark

Review & Sign Reconciliation Payment (Step 12)

Checkmark

Communications

Draft & Mail Annual CMS Creditable Coverage Notices to Eligible Individuals

Checkmark

Monitor Impact of RDS & CMS Announcements

Checkmark

Record Keeping for CMS Required Six Years

All Application Materials & Payment Requests

Checkmark

All Actuarial Reports/Studies

Checkmark

Provide Support and Documentation for CMS Audits

Checkmark