PDE Reconciliation
Due to the complexity of Part D, health plan Pharmacy Management/PBM Operations, IT, Enrollment, and Finance must work together to achieve successful PDE processing.
In most organizations these functions do not share a mission--- let alone people, processes or tools. For
PDPs , the effort is made even more challenging due to the auto-enrollment of members, among many other factors.
It takes an experienced, knowledgeable, strong cross-functional team to successfully manage this vitally important operation. GHG can help you optimize PDE processing by bridging these gaps through a combination of expert guidance, staffing and proprietary reconciliation software.
The heart of our solution is Valencia, a software tool that serves as a single source for CMS membership, payment and reconciliation data. Valencia also connects PDE data with the critical annual Part D estimated settlements. By bringing these data into one place, our reconciliation analysts can quickly research and resolve individual errors, speeding through the backlog so that your internal staff can focus on ongoing business. And our unsurpassed industry knowledge means that the strategic fixes—including adapting plan workflows and procedures to point your plan towards better ongoing processing—can happen alongside an error-resolution engagement.
Whether speaking of our technology or our professional services, GHG's solution will be designed around identifying and fixing the root cause issues and broadens to cover PDE errors that plans may experience as a result of actions by your PBM and IT department as well.
For more information, please contact Recon@gormanhealthgroup.com .
