The CMS allows for Plan Sponsors to “go back” and review their previous RDS filings for additional subsidy and compliance issues provided they meet the stringent requirements for reconsideration and Part D Advisors can help. Our goal is to maximize subsidy payments from previously reconciled applications for Plan Sponsors by handling the entire RDS reopening appeals process for our clients. Over a decade of experience, we’ve developed a suite of proprietary, custom built software designed to increase a Plan Sponsor’s subsidy by focusing on three key areas: member eligibility, drug filtering and claims matching. After ten years in the business, we’re confident when we say our unmatched tools and methodology lead to an average increase of 8-15% more subsidy dollars.

Even if a Plan Sponsor has left the Retiree Drug Subsidy program for an EGWP, MA or PDP plan, they are still eligible to reopen their previous RDS applications. In fact, if your group has or will move to a plan that is ineligible for the Retiree Drug Subsidy, now is a great time to reopen previously reconciled years. On top of finding more subsidy dollars, Plan Sponsors get the added benefit of reviewing their past applications for compliance issues in case of a potential CMS audit. Additionally, PDA’s decade of experience has shown us that a reopening can often help to ease the transition between plans for Plan Sponsors because it allows them to focus on the future while PDA handles the old claims on their behalf.

Best of all, PDA’s RDS reopening services are entirely risk free. Our track record of successful reopenings coupled with our proprietary process makes us so confident that we’ll identify and collect additional subsidy dollars for our clients that our services are provided on a contingency fee basis, which means clients are only billed for a percentage of the additional subsidy collected once the money is received; no upfront costs for our customers and no charge at all unless additional money is collected. Finally, whether or not additional subsidy is collected, as a standard part of PDA’s RDS reopening services, PDA will warehouse all data and documentation for the requisite six year term and support the Plan Sponsor in the event of a CMS audit. There’s nothing to lose!

Examples of PDA’s successful RDS reopening services can be found on our industry-specific pages for Labor Unions, Private Corporations, and Governmental Organizations.

A Printer-Friendly Version of PDA’s RDS Reopening Timeline is Available on our Documents Page.

Step One | Documentation and Data Gathering ▼

During this first phase of the reopening process Part D Advisors works with your PBMs, TPAs, and/or Brokers to collect and consolidate all pertinent data into our proprietary database. Generally, this process takes about 1-2 months, depending on the volume of data.

Step Two | Begin Data Review ▼

Once PDA has collected all the necessary data, we begin applying our unique drug filter, eligibility scanners and claims matching algorithms to the data, seeking out every last subsidy dollar a Plan Sponsor is entitled to. This stage of the process will generally last 1-3 months.

Step Three | Generate a New Cost Report ▼

Now that PDA is confident we’ve maximized the subsidy payment for the plan Sponsor, our expert BAs create a new cost report for the Reopening Application. Creating a new cost report only takes about 1-2 weeks to generate.

Step Four | Submit the Reopening Appeal ▼

With all the data expertly investigated and analyzed, PDA’s experienced Account Managers send the reopening appeal to the CMS for review. Getting all the necessary documentation together takes about 1-2 weeks and the appeal is out the door!

Step Five | Wait for Approval/Continue Data Review ▼

While it’s hard to judge how long it will take for the CMS to reply to a reopening request, in PDA’s experience it can be anywhere from 1-2 months. However, our Business Analysts and Account Managers aren’t just sitting around waiting for an answer; they’re hard at work, continuing to investigate and analyze a Plan Sponsor’s data, double and triple checking their work for any over looked subsidy dollars.

Step Six | Complete the Reopening ▼

Once the appeal is approved, PDA spends the next 3 months “redoing” the 12 step final reconciliation process, maximizing subsidy dollars along the way.

Step Seven | Resubmit the Final Reconciliation ▼

At the end of 3 months, the Plan Sponsor’s Authorized Representative resubmits the final reconciliation (with the assistance of PDA’s Account Managers of course). Next, PDA waits for a response from the CMS. Again, while it’s hard to judge how long the CMS takes to review and respond to the new reconciliation, in our experience we hear back in about 1-2 weeks.

Step Eight | Submit Payment Justification if Required ▼

Sometimes, the CMS requests additional information from PDA to justify the increase in the subsidy payment we’re requesting on behalf of the Plan Sponsor. As one of the very first in the industry to market reopenings for value, PDA is ready, willing and more than able to provide this evidence to the CMS if and when it is requested. Generally, this process takes about 2-4 weeks, depending on the response time of the CMS.

Step Nine | Wait for Payment ▼

Now the fun part! Now that the CMS is certain of PDA’s subsidy payment request, it’s only a matter of 2-4 weeks before the Plan Sponsor receives their money via EFT. For an experienced industry leader like PDA, the whole process from start to finish is, on average, completed in just 6-12 months and can result in as much as a 15% increase in subsidy payments. Best of all, PDA’s reopening services are risk free, meaning we don’t get paid until you get paid.

RDS Services

• Ongoing RDS Services
• RDS Reopening Services
  • RDS to EGWP Transition