STREAMLINING CMS RXDC REPORTING
What is RxDC Reporting?
The Consolidated Appropriations Act, 2021 created a data collection (RxDC) requirement for insurance companies, pharmacy benefit managers (PBMs), and employers sponsoring group health plans. These entities must submit detailed information about prescription drug and health care spending on an annual basis to the Department of Health and Human Services (HHS).
What Should I Do?
RxDC reports include a file of plan information (P2), details about the plan’s enrollment information, and allocation of premium dollars (D1), plus seven additional data files (D2-D8) that reflect statistics about the plan’s prescription drug usage and medical claims data. The report for the 2023 reference year, which is due by June 1, 2024, contains information based on what happened in the calendar year 2023.
How Can CXC Help?
Employers working with a health insurer, TPA, or PBM to submit D1 files on their behalf will likely encounter a tight deadline to give their vendor employer-specific information for these filings. For employers whose carrier/TPA/PBM is unwilling or unable to submit D1 on their behalf or for those who have missed their vendor’s deadline, CXC is available to prepare and submit D1 and P2 files for your organization.
Our Services
D1 & P2 Reports Submission to CMS
Submission to CMS of Narrative Responses
Plan Information & Rx Data Collection
Access to Designated RxDC Reporting Specialist
Opportunity to Review Filing in Advance
Final Confirmation of Electronic Filing
Understanding the Importance of RxDC Reporting
Control Costs
Understanding the detailed landscape of drug spending and usage patterns empowers employers, insurers, and other healthcare stakeholders to formulate strategies for cost containment. These strategies may include negotiating better rates with providers, for cost-effectiveness, and implementing wellness programs.
Improve Healthcare Efficiency
The reporting process encourages organizations to closely examine their healthcare spending and prescription drug use, leading to more informed decision-making. By identifying inefficiencies and areas for improvement, entities can enhance the value of the healthcare services provided to beneficiaries.
Facilitate Benchmarking
Organizations can leverage RxDC data to benchmark their healthcare spending against industry standards or peers. This benchmarking can reveal outliers in drug spending or utilization, guiding organizations toward more cost-effective healthcare practices and policies.
Our Differentiation
Designated RxDC Specialist assigned
Personalized Expertise: Every client is paired with a designated RxDC Specialist, ensuring tailored guidance and expertise throughout the reporting process.
Comprehensive review of all reports
Thorough Analysis: Each report undergoes a comprehensive review to ensure accuracy and completeness, adhering to the stringent requirements of RxDC reporting.
Data is validated for common errors
Error Mitigation: We employ advanced validation techniques to identify and rectify common errors before submission, significantly reducing the risk of rejection or queries from CMS.
Pre- and post-e-Filing support available
Comprehensive Assistance: Our support extends beyond the initial filing, covering both pre- and post-submission phases to address any issues or questions that may arise.
Consistent Support: Your specialist will be your point of contact, offering consistent support and answers to all your queries, making the complex reporting journey smoother.
Attention to Detail: Our meticulous approach covers every aspect of your submission, safeguarding against oversights and enhancing the quality of your reports.
Quality Assurance: This proactive step ensures that your data meets all regulatory standards, offering you peace of mind and confidence in your compliance.
Ongoing Engagement: We stay engaged with our clients after e-filing, offering assistance with potential audits, and feedback, and preparing for future reporting cycles, ensuring continuous compliance.
Frequently Asked Questions
What is RxDC Reporting?
It is required by the Consolidated Appropriations Act of 2021, which mandates certain entities to annually submit detailed information about prescription drugs and healthcare spending to enhance transparency and regulatory oversight.
Who needs to comply with RxDC?
Insurance companies, pharmacy benefit managers (PBMs), and employers with group health plans must comply with RxDC reporting instructions requirements.
What information is included in CMS RxDC reporting instructions?
An RxDC report includes plan information, enrollment details, premium allocations, and data files detailing prescription drug usage and healthcare spending.
How does having a designated RxDC Specialist help?
A designated RxDC Specialist provides personalized guidance, ensuring that your reporting process is accurate, efficient, and compliant with regulatory standards.
What does the comprehensive review of reports involve?
The comprehensive review involves a thorough analysis of your report to ensure accuracy, completeness, and compliance with all CMS RxDC reporting.
How do you validate data for common errors?
Our validation process includes checking the data against known common errors and employing advanced techniques to identify and rectify any discrepancies before submission.
What kind of pre- and post-e-filing support do you offer?
Our support encompasses assistance with data collection, report preparation, submission queries, and dealing with any post-submission requirements or audits.
Can you handle reports for any size of organization?
Yes, our services are scalable and tailored to meet the needs of any organization, regardless of its size, ensuring that both small employers and large insurers can comply effectively.
What happens if there’s an error in the report after submission?
If an error is identified post-submission, we provide support to correct and resubmit the report as necessary, working closely with you to address any issues raised by CMS.
How can I get started with your RxDC reporting services?
Getting started is easy. Contact us through our website or call our customer service line to schedule a consultation. We’ll discuss your needs, explain our services, and outline the next steps to ensure your reporting is handled expertly.