GPS: Retiree Drug Subsidy (RDS) Service Offering
For 2007, GPS will support plan sponsors contracted with the Centers for Medicare and Medicaid Services (CMS) to participate in the Retiree Drug Subsidy (RDS) program. GPS’s RDS support services include:
Eligibility Submissions and File Maintenance
- Receive monthly enrollment files from plan and identify enrollment changes
- Format eligibility changes into RDS file specifications and submit monthly change file to CMS
- Process CMS’s monthly change file responses and return reports to plan
- Download and process CMS’s weekly enrollment changes and return reports to plan
- Maintain an enrollment database using response files and weekly notification files for use in generating interim cost reports and performing reconciliation requirements
- Maintain a member ID / SSN / HICN crosswalk from RDS enrollment database to claims database for proper payment and reconciliation reporting (service available as needed)
Interim Payment Reporting
- Identify claims for approved RDS beneficiaries
- Remove claims excluded from the Medicare Part D program
- Adjust gross costs for Medicare Part B drugs based on CMS approved methodology
- Provide interim cost report with accumulated gross retiree cost, threshold reduction and limit reduction amounts by month
- Provide as part of the interim cost report, monthly estimated cost reduction (rebates, discounts, charge-backs, etc.) amounts
- Supply plan with interim cost reports in accordance with the plan’s elected payment frequency
Reconciliation Services
- Reconcile plan enrollment to CMS approved enrollment and provide plan with discrepancy records
- Provide claim file in required specification listing accumulated amounts for gross retiree cost, threshold reduction and limit reduction by month with beneficiary level detail provided for record maintenance and auditing purposes
- Provide report listing actual cost reduction (rebates, discounts, charge-backs, etc) amounts for plan year
- Reconcile year end reporting to interim payment requests and assess plan overpayment / underpayment amounts
- Provide reconciliation information to the plan for submission to CMS
RDS Communication Support
- Provide plan with template language for Notices of Creditable Coverage OR
- Develop and disseminate Notices of Creditable Coverage to Medicare eligible members
- Develop member newsletters / custom communications on RDS program or plan benefit changes
RDS Interim Payment Audit
- Load plan sponsor interim payment reports and corresponding claim/beneficiary level detail
- Load NCPDP 2.0 claim file, reconcile to file statistics and prepare file for processing
- Remove claims for unapproved RDS beneficiaries and claims incurred outside of beneficiary effective period(s)
- Remove claims excluded from the Medicare Part D program
- Query claim information to accumulate amounts for Gross Retiree Cost (GRC), Threshold Reduction (THR) and limit reduction (LR)
- Calculate Gross Eligible (GE), Estimated Cost Adjustment* (ECA), Allowable Retiree Cost (ARC) and Subsidy Amount (SA)
- Accumulate RDS interim payment cost fields at a beneficiary level
- Compare GPS generate RDS cost fields to plan sponsor’s payment report cost fields and identify discrepancies
For 2008, GPS will continue to support plan sponsors contracted with CMS to participate in the RDS program. In addition to the services available in 2007, GPS can provide the following:
