PDE Archives - BluePeak Advisors

CMS Compliance PBM PDE

The PDE Submission Deadline is Rapidly Approaching-Don’t Assume a High Acceptance Rate Translates to PDE Accuracy

The 2021 PDE submission deadline is June 29, 2022. Plans must attest to the accuracy of their submitted PDE records prior to CMS’ financial reconciliation. The challenge is that many…

BluePeak AdvisorsFebruary 12, 2022

CMS PDE

Financial Audits: Lessons Learned

Financial audits are just one of the many types of Medicare Part D audits. Financial audit frequency and awareness continues to increase, and plans are realizing that they must integrate…

BluePeak AdvisorsSeptember 9, 2019

Audits CMS MA-PD PDE

Audit Experiences Underscore the Importance of the Additional Beneficiary Information Initiatives (ABBI) Database

Prior to 2019, plan sponsors were required to make an effort determine whether an immunosuppressant should be paid under Part D or Part B based upon information they had or…

BluePeak AdvisorsSeptember 9, 2019

CMS Marketing MCMG PDE Training

BluePeak’s Definitive Guide to Preparing for 2020

Bids were turned in the first Monday in June and now it is time to implement those benefits, plan designs and formularies that your organization has been hard at work…

BluePeak AdvisorsJune 11, 2019

CMS FWA Part D PDE RAPS

CMS Increases Percentage of Encounter Data on Which MA Plans’ Payments are Based

According to the Final Call Letter, the Centers for Medicare and Medicaid Services (CMS) will increase the percentage of encounter data, on which part of Medicare Advantage plans’ pay is…

BluePeak AdvisorsMay 15, 2018

CMS Medicaid Medicare PDE

ICYMI – BluePeak’s Articles posted recently on LinkedIn

CMS Account Managers May Contact Plans to Assess New Medicare Card Project Readiness PDE Self-Audits Cost At Least One Plan Over $1 Million in Claims Reversals CMS to Conduct Provider…

BluePeak AdvisorsMarch 6, 2018

CMS Part C Part D PDE

PDE SELF AUDITS in 2018

Throughout 2017, CMS continued its vigilance over drug claim payments by conducting Prescription Drug Event (PDE) Self-Audits. The drugs under audit in 2018 may change, but CMS has not yet…

Kelly Makay, RPh. MBAJanuary 19, 2018

CMS PDE

Encounter Data – It’s Not Just Claims Data Anymore.

Background CMS began capturing encounter data several years ago from plans. The long- term intent of using this data was for risk adjusted payment purposes, as well as to be…

Nancy EricksonOctober 17, 2017