Year-end testing is essential to validate claims accuracy, ensure compliance with IRA mandates, and confirm PDE reporting integrity. This process guarantees that your systems are prepared for the new contract year and that members receive the benefits promised. Without thorough testing, plans risk costly errors, member dissatisfaction, and regulatory penalties.
Testing includes verifying adjudication of claims, applying manufacturer discounts correctly, and ensuring insulin pricing and vaccine coverage meet CMS requirements. It also involves simulating real-world scenarios to confirm operational readiness and prevent disruptions. Year-end testing is not just about compliance—it’s about protecting your reputation and your members.
The strategic value of year-end testing is clear: it demonstrates proactive compliance, builds CMS confidence, and enhances member trust. Best practices include following CMS testing guidelines, conducting end-to-end testing for claims and PDE reporting, and auditing critical areas like ACIP vaccines and insulin pricing. Registering key staff for CMS calls ensures your team stays informed on evolving requirements and ready for January 1.
BluePeak can help!
BluePeak provides Part D support, including claims testing and PDE validation. We can ensure your bid, member materials, and claims systems align for 2026 compliance with a Quarter 1 review. Contact us at info@bluepeak.com to schedule your year-end testing and start the new year with confidence.
