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
Identify all Unique Benefit Options (UBOIs) within a Group Health Plan (GHP)
Supply Data
Supply Data
Identify Retired Medicare Eligible Individuals (RMEIs)
Regular Eligibility Updates
Provide Actuary for Gross & Net Test Attestations
Obtain Eligibility & Claims Data
Coordinate Monthly Individual Eligibility & Claims Data
Supply Data
12 Month Eligibility & Claims Data for Final Reconciliation
Supply Data
Monitor Eligibility & Claim Data for Final Reconciliation
Monitor Application-Specific RDS Requirements & Deadlines
Receive & Incorporate CMS’ Weekly Eligibility Updates
RDS Website Account Setup & Maintenance
Register GHP & Plan Sponsor with RDS
Be Designated at Account Manager (AM)
Designate Authorized Representative (AR)
Designate Actuary
Register as a Cost Reporter (CR) Designee
Register as a Payment Requester (PR) Designee
Complete Payment Setup
Application Setup & Maintenance
Complete Sections 1-3 & 5-7 & 9 of Application
Upload Retiree Census Data to RDS Website
Actuary Completes Section 5 of Application
Review and Sign Section 9 of Application
Monthly Payment Request Process
Receive and Review Monthly Claim Information
Adjust Claims & Filter for Non-Part D Drugs
Adjust Claims for Estimated Rebates
Calculate Subsidy Amount for Each RMEI
Calculate Aggregate Subsidy Amount for all RMEIs
Handle RDS Denials, Inquires & Responses
Submit Monthly Subsidy Payment Request
Annual Reconciliation 12 Step Process
Finalize Covered Retirees List
Compile Final Rebate Data
Supply Data
Supply Data
Generate and Manage Final Cost Reports
Finalize Reconciliation Payment Request
Review & Sign Reconciliation Payment (Step 12)
Communications
Draft & Mail Annual CMS Creditable Coverage Notices to Eligible Individuals
Monitor Impact of RDS & CMS Announcements
Record Keeping for CMS Required Six Years
All Application Materials & Payment Requests
All Actuarial Reports/Studies
Provide Support and Documentation for CMS Audits