PARTI
ADVISORS
Additionally, PDA can use medical data to identify drugs that are either Part B or Part D drugs depending on the
situation in which they are administered.
The Medicare Database as the Source of Truth
Historically, a primary factor limiting most Plan Sponsors’ success with the RDS has been CMS membership
rejections. Eligible retirees can receive CMS rejection codes if the demographic information submitted is not an
exact match for the Medicare database. If the Medicare database contains an inaccurate record or if required
information such as social security numbers are unavailable for certain members, the plan sponsor will have little
recourse to correct the submission. Further complicating this problem is that the most common rejection codes
do not provide any detail as to what information was incorrect in the membership record. RDS website users
submitting retirement lists are left with very limited options to correct these rejections with the tools and resources
available to them.
Navigating the Reopening Process
PDA’s account team will work with the City of Nashua through all portions of the RDS reopening process. Our
system is designed to minimize the effort needed by the City while maximizing additional subsidy. Reopening
multiple applications can take up to 6-12 months during which time PDA will do the heavy lifting reducing our
customer's workload to just a few hours per application.
The deadline to reopen a reconciled RDS application is four years from the original determination date meaning
deadlines are often fast approaching. To meet this challenge, PDA’s team of full time Software Developers added
Task Manager to our existing software suite. Task Manager is a one of a kind tool that organizes the RDS
reopening process into specific tasks with a set project schedule based on our extensive RDS reopening
experience. Task Manager communicates with our other proprietary software tools to help our account teams
create estimates, update eligibility, filter claims, match members, create cost reports, and much more. This
unique set-up gives our team the ability to process reopenings for all reconciled applications (for which data is
available) at the same time. This greatly minimizes the plan sponsor's risk of losing opportunities to reopen and
brings in the most additional subsidy as quickly as possible.
Contingency Pricing Arrangement
PDA’s RDS reopening services are entirely risk free and the City would not be invoiced until after they
have received additional dollars from CMS. The entire reopening process from start to finish is provided on a
contingency fee basis, which means no charges whatsoever unless additional money is collected. Most
importantly, whether or not additional subsidy dollars are received, PDA will still warehouse all data and
documentation for the requisite six year term and support City of Nashua in the event of a CMS audit.
In consideration of our long standing relationship with Workplace Benefit Solutions and HUB International, PDA
has cut our standard fees in half. PDA is offering the City of Nashua our reopening services for 20% of the
additional subsidy collected.
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