Prescription Drug Event  

360PDE® is a business-configurable workflow solution for processing, updating and tracking prescription drug event (PDE) submissions to CMS for Part D payment reconciliation. MedHOK ensures that PDE data is submitted in the CMS accepted formats with all required data elements. Our PDE claims processing application contains internal edits to ensure a proactive approach to identifying irregularities in data calculations of PDE financial fields and non-covered drugs prior to submission. Rejected internal PDE claims as well as CMS rejected claims are automatically routed to the appropriate reject queue for immediate correction and resubmission to CMS. Analysis of both internal and CMS rejected claims allows for a proactive approach by management to eliminate future rejects and in turn decreases financial losses for the plan.

Key Features:

• Flexibility in the generation of new PDE data elements per CMS guidance.
• Flexibility in loading plan or PBM Rx claims files.
• Timely generation and submission of PDE records to CMS based on client preference.
• PDE records accurately reflect primary and secondary payments when applicable.
• Reconciliation of PBM plan claims to PDE submitted claims.
• CMS response files reviewed and reconciled.
• Validation of PDE submissions and prioritization of errors needing correction based on type of error and financial return.
• Identification of loss revenue based on claims for non-covered benefits.
• Reports summarizing accepted and rejected PDE records, rejection details and additional reports focused on LICS rejections and Part D non-covered drug rejections.
• Automated reject routing to work queues and business partner queues for claim correction.
• Real-time dashboard for management monitoring.