Administering a Retiree Drug Subsidy program is a complex and highly administrative activity that can consume valuable time and resources. Having an experienced and knowledgeable program administrator can give you the confidence and peace of mind that your program is being effectively managed.
Our team of specialists at RDS Services, LLC understands the intricacies of CMS compliance requirements, allowing us to uncover and secure the maximum amount of subsidy available to you.
Full-Service RDS Program Support
RDS Services, LLC offers a full suite of RDS program services, including the following:
- Original application and reconciliation management
- Ongoing RDS program management
- Data aggregation services
We know and understand the ins and outs of the RDS program, ensuring that you collect 100% of your eligible drug subsidy dollars.
RDS Application and Reconciliation Management
When you engage with us, our team of experts will become the designated Vendor, Cost Reporter Designee, and Account Manager on all RDS applications. We’ll work with you to establish efficient procedures for maintaining and updating retiree lists.
As the Account Manager for your application, we will:
- Manage all tasks associated with application, including reconciliations, CMS audits, and inquiries
- Audit, review, and upload retiree lists to RDS for approval
- Complete the RDS Application
- Ensure that all application requirements are completed 90 days prior to Application Plan Year
- Coordinate benefit option information with actuaries
- Troubleshoot application errors
- Complete payment setup requirements
Ongoing Services
Once an RDS application is submitted to the CMS, there are ongoing activities that need to be managed to ensure program compliance. In addition to our RDS application management services, we offer RDS administration services—with and without data aggregation services.
RDS Administration Services
RDS Services, LLC offers the following RDS administrative services, including:
- Reviewing & communicating response files and weekly notification rejections and codes
- Providing guidance on how to rectify the issue of retirees that have enrolled in an individual Part D plan
- Completing steps 11 of 12 of Annual Reconciliation for CMS prior to 15 months after the end of each Plan Year
- Overseeing any CMS audit activities
- Providing annual Creditable Coverage letters
- Submitting payment requests on behalf of the client, with notification to the client of the amount submitted
Data Aggregation Services
In addition to the ongoing administrative services, RDS Services, LLC has created a unique and proprietary tool that allows us to efficiently aggregate very complicated data sets of multi-year membership and drug claims. The ability to review and understand the entire population of data allows transparency and oversight that can greatly improve program outcomes.
Summary of additional data aggregation Services:
- Establishing procedures between RDS Services and vendors to provide drug claim lists
- Compiling drug claims lists and maintaining a database of Part D eligible drugs
- Scrubbing claim data to comply with CMS formulary (Part D Rx exclusions)
- Determining Part B exclusion methodology
- Generating a system-assigned unique identifier by using multiple data sources
- Running stored routines to identify unassigned drug and medical claims to members and their associated SSN/HICN
- Maintaining a drug claim database
- Aggregating, analyzing, correcting, and managing retiree eligibility records
- Tracking RDS thresholds and limiting reductions per plan year
- Calculating estimated cost adjustments/rebates (actual cost adjustments during reconciliation)
- Developing cost reports in compliance with CMS standards
- Modifying a drug claim database for mid-year plan changes
- Reviewing cost reports and correcting inaccuracies if needed
- Submitting cost reports to RDS
- Troubleshooting cost reporting submission problems
