Timely Submission of Prescription Drug Event (PDE) Records and Resolution of Rejected PDEs

A new schedule has been introduced to submit PDE data in a timely manner to CMS. Below, is the updated schedule for submitting PDE data:

• Submit original PDEs within 30 days following Date Claim Received or Date of Service (whichever is greater)
• Resolve rejected records and re-submit within 90 days following receipt of rejected record status from CMS (prior guidance stated 45 days)
• Submit adjustments within 90 days of discovery (prior guidance stated 45 days) and
• Submit adjustments and deletions within 90 days following discovery of issue requiring change (prior guidance stated 45 days)

How will this affect you?
For the rest of the year, CMS expects client to follow the above submission schedule. CMS will gather metrics on PDE data to determine current lag on PDE submission data. Full compliance activities will begin in 2012, although CMS will notify health plans in 2011 with issues meeting the 30 day window.

CMS will begin the compliance monitoring process in 3 phases:

• Monitoring timeliness of original PDE's
• Monitoring timeliness of resolving rejected PDE's
• Monitoring timeliness of adjustment/deletion PDE's

Please ensure you communicate this information to your PBM.

PLEASE NOTE: The Health Plan has the responsibility to ensure that their data is sent to CMS in a timely manner.

Stay Compliant with Dynamic
Dynamic's focus is to ensure Medicare Advantage Plans have the tools and resources to maintain compliance and ensure accurate premium payments from CMS and beneficiaries. Dynamic offers a comprehensive PDE management toolkit that allows Plans to avoid discrepancies that can result in regulatory sanctions and penalties.

Click here to obtain more information about Dynamic's PDE solution or contact our Sales Team at sales@dynamichealthsys.com