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 plans, and Pharmacy Benefit Managers (PBMs), don’t have the expertise and/or resources to perform a comprehensive review of their PDE records to be confident in their attestation.
A significant misunderstanding within the industry is a favorable PDE acceptance rate translates into accurate PDE records. However, CMS does not edit on PDE accuracy, and a high PDE acceptance rate could disguise reporting and reprocessing opportunities resulting in financial loss and an increase in compliance risks.
A comprehensive review of the PDE records targets opportunities to optimize financial reconciliation, mitigates compliance risks, and enhances monitoring and oversight over the PBM.
With four months remaining till the 2021 PDE Submission Deadline, Plans can act now to proactively resolve PDE records that have not been accepted, validate the data and reporting accuracy of PDE records, and identify members that need to be restacked and made whole. BluePeak has developed a robust PDE Compliance Optimization Tool that will identify data and reporting inconsistencies within the PDE records as well as identify members that need reprocessing.
BluePeak has closely collaborated with many plans and PBMs to identify opportunities, provide a remediation roadmap, and validate any inaccurate records that have been sent into CMS are fully remediated. Plans can go into the PDE submission deadline feeling confident in attesting to the accuracy of their PDE records, assured they have optimized their PDE reconciliation amount, and comfortable knowing they have likely mitigated several compliance risks that could have been identified in a CMS financial audit.
