Solutions

PDE Management Solution

Plans are required to submit to CMS detailed financial transactions for each prescription filled under the Part D benefit called Prescription Drug Event transactions (PDE).  Most Plans delegate the ROLE of creating and submitting these transactions to their Pharmacy Benefit Management (PBM) vendor/partner.  However, the Plan cannot delegate the responsibility of ensuring the timely submission and error correction/resubmission of the transactions to CMS.
In addition to monitoring and reconciling the data submission work flow, the Plan must also ensure the content of the data in the transactions are accurate and correct.  Errors in the data or missing data will both make the payments from CMS to the Plan inaccurate and will place the Plan out of CMS compliance requirements.

The PDE Management Module is responsible for identifying drug claims that have not been submitted on a PDE and PDE transactions that have been rejected by CMS and why.

The PDE Audit Module is responsible for creating an internal view of PDE transactions that are used to identify inaccurate cost and payment calculations in the PDE transactions created by a PBM and sent to CMS.