RDS Reopen VerifyLink^©

There are Many Reasons Why You Can Benefit from an RDS Reopening... and Only One Partner to Help You Find Out — InTech

If you did not average $550 per eligible retiree in every plan year in which you participated, you may have not captured all your RDS subsidy money. But you cannot find out until you spend a lot of time and effort to demonstrate to CMS that an RDS Reopen is justified

Unless... you get InTech to audit and submit your RDS Reopening for you.

Working together with your staff, or your Benefits Administrator, and PBM, InTech will conduct a comprehensive audit from which the results will demonstrate to CMS that an RDS Reopening is justified. Once CMS approves the request, InTech will manage the Reopening reconciliation process including all of the technical and compliance issues associated to retiree eligibility, data accuracy and matching, rebate verification, cost report calculations and assist you with closure of the Reopening reconciliation steps. InTech will prepare all CMS documentation and perform the file transmissions needed to get the additional payments you are due... for every year involved.

Here are Just a Few of the Reasons You May be Missing Out on a Larger RDS Subsidy

• Incomplete covered retiree list or unresolved retiree eligibility issues
• Missing or inaccurate claim information related to plan sponsor identifier, member subscriber number, payment amount, NDC code, quantities of medications dispensed
• Claim files inaccuracy in accordance to RDS medication inclusion and exclusion requirements
• Cost report calculation errors
• Complications in matching eligible retirees and claims files
• Incomplete retiree lists provided between plan sponsor and PBM or health plan
• Anomalies in utilization per retiree indicating that utilization is too high or too low
• Rebate percentage inconsistency or inaccuracy
• Inaccurate or inconsistent data linkage between retiree eligibility information and the plan sponsor's claims

An Overview of the RDS Reopening Process:

If you believe you may not have received the maximum RDS reimbursement for a previously submitted year due to any of the reasons shown above, CMS will now allow you to reopen a previously reconciled plan year. This process can be done up to four years post reconciliation of a plan year. The overall review and analysis is time consuming, complicated, and not something most plan sponsors are able to do without having the analytical tools and expertise to identify the specific data or processing issues causing the subsidy shortfall.

To reopen a plan year, you must first provide CMS with a written notice identifying what issues or errors may have been involved in the past plan year and what is the expected increase in reimbursement. To determine the "new" subsidy total, an audit is done to reevaluate all past data and the RDS processes used to identify what could have potentially caused the subsidy shortfall. For example, as part of the reopen process, CMS allows past plan year retiree eligibility information to be resent to validate and correct past eligibility rejection issues. Adding additional eligible retirees, or correcting subsidy eligible time frames, will result in an additional subsidy for that plan year.

Once the information and documentation is prepared, CMS will then review your request and reply to with a determination allowing or disallowing a reopening. This review and reply process takes approximately 30 days.

If CMS responds with a favorable determination to reopen the plan year, you will be notified that you have a 90 day deadline to resubmit the appropriate information and request payment. The reopen process follows the same administrative steps as an annual reconciliation and upon completion of all the reconciliation steps CMS will electronically pay the additional subsidy in thirty days or less.

You can go to the RDS website to see the list of Questions and Answers about the RDS appeal process at:
http://rds.cms.hhs.gov/cqs/cq_appealDetermination.htm.

Save Time, Effort and Get the Maximum RDS Subsidy Reimbursement when You Partner with InTech for RDS Reopening.

Call to Schedule YOUR RDS Reopening Audit Today…and make sure Your Organization Gets Total Reimbursement for All Your Eligible Retirees!