Medicare Part D

Our team of clinicians, managers, and software developers is ready to assist with the implementation, administration, and continuous compliance of your Part D program. Our systems have been developed specifically for Managed Care and provide real-time claims processing according to complex Part D benefits, including proper True-Out-Of-Pocket (TrOOP) calculations and Coordination of Benefits (COB).

 We will work in cooperation with all medical vendors to arrange for HIPAA-compliant, dual-direction data exchanges. Data coordination includes enrollment (with determination of effectuated members), accumulators (medical and pharmacy OOPs, deductibles, maximums, etc.), claims data, physician encounters, prior authorization information, Explanation of Benefits (EOBs), transition letters (if applicable), and other requisite digital files. Our end-to-end solution incorporates the following:

• Customized, CMS-approved formulary management
• Benefit design consultation and development of clinical protocols
• Easy-to-navigate Member Portal
• Member EOB generation
• Medicare Plan Finder integration
• Prescribing transaction processing
• Accurate and timely Prescription Drug Events (PDE) management
• TrOOP tracking and data coordination/transfer
• Retroactive Low-Income Subsidy (LIS) management
• Administrative PC-based eligibility software and support
• CMS-ready file formatting/reporting