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ADVISORS
PDA’s RDS Reopening Process
Part D Advisors (PDA) is the Retiree Drug Subsidy (RDS) industry leader with more than a decade of experience.
Since our founding in 2005, PDA has established the gold standard in RDS administration, providing support
and recovery services for nearly 300 plan sponsors across 30 states. PDA has built our subsidy improvement
process around our proprietary software suite and experienced account team. The City of Nashua now has a
risk free opportunity to engage PDA in reviewing its historical RDS filings to identify additional dollars while
securing its RDS records in our database the CMS required six years of audit support.
City of Nashua’s Reopening Opportunity
The Centers for Medicare and Medicaid Services (CMS) allows plan sponsors such as City of Nashua to reopen
previously reconciled applications for up to four years after the original reconciliation date. Our one-of-a-kind
methodology and custom built software can help City of Nashua improve its total subsidy recovery by an average
of 8%-15%; an increase of as much as $115,000. The following chart is derived from information published
annually by CMS and shows City of Nashua’s historical subsidy collection from 2012 & 2013.
Plan Year | Retiree Count Original Subsidy 8% Improvement 15% Improvement
2012 352 $ 278,629 | | $ 22,290 $ 41,794
2013 810 $ 494,434 $ 39,554 $ 74,165
Totals: 1,162 $ 773,068 $ 61,844 $ 115,959
How Does PDA Recover Additional Subsidy?
The PDA Reopening Process takes an entirely new approach to the RDS by utilizing custom tools designed to
combine membership, Rx claims, and medical data together to increase the value of each dataset. This approach
provides benefits that couldn't be achieved when membership, claims matching, and cost reporting are handled
by different parties. PDA’s software focuses on three main areas to provide additional value:
Improved Membership
PDA collects and reviews as many sources of eligibility information as possible, including census files, pension
lists, and alias information gleaned from claims files. Rather than have the Plan Sponsor create the retiree lists
and work with the RDS to correct legitimate members who get rejected, PDA has built custom software to store
and review this information so that RDS rejections can be reversed quickly and accurately.
Improved Claims Matching
PDA’s review of claims and eligibility from multiple sources enables us to store every potential member alias and
link it back to an approved member record. This combined review allows PDA to build a vast database of Social
Security Numbers and Health Insurance Claim Numbers (HICNs) which are then used to match up all the claims
for cardholder/contract groupings.
Improved Drug Filtering
PDA has built a custom drug filter with the sole aim being accuracy in RDS filings. Our drug filter is reviewed and
updated on a monthly basis based on advice from our clinical pharmacist and a review of the Medispan database.
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