PHARMACY
MAPDs and PDPs share similar challenges addressing Part D program compliance risks
The rapid changes to Part D regulations make the tracking and implementation of these CMS requirements exceptionally difficult — to say nothing of actually managing to them. The challenge is magnified by reliance on delegated entities to perform core Part D functions.
We can help your MAPD or PDP develop and implement efficient and compliant internal operations and prepare effectively for CMS audits with professional services and unmatched compliance tools. Our broad array of services can assist you in post-audit remediation, implementation of best practices, PBM contracting and implementation, interim staffing, clinical process re-engineering, Star Ratings improvement, and claims and PDE assessment and adjustments.
Our Part D services are designed with your staff in mind, ensuring that with a mix of counsel and DIY tools your staff will have access to actionable information – faster. Don’t chase data points. Spend your time on the things that will impact your audit results when a CMS audit comes – and it always does.
Audit Prep and Remediation
We can help your MA-PD or PDP develop and implement efficient and compliant internal operations and prepare effectively for CMS audits with professional services and unmatched compliance tools. Our broad array of services can assist you in post-audit remediation and implementation of best practices.
Benefit Administration Testing
GHG’s Pharmacy experts can create and conduct an in-depth benefit administration test plan for your organization to validate that everything is working precisely as it should before the new plan year begins as well as on an ongoing basis throughout the year. We can ensure your PBM is processing claims consistent with your CMS-Approved Prescription Drug Benefit.
Delegation Oversight
In today’s regulatory environment, it’s critical that your PBM and other delegated entities perform flawlessly. With GHG’s in-depth delegation oversight assessments, our experts can help your organization learn where and how to verify potential issues and identify risk – empowering your teams to ask the tough questions.
Part D Operations
Gorman Health Group provides expert guidance related to regulatory and operational issues to help alleviate risk for the Prescription Drug Benefit program. We can help your MA-PD or PDP and their downstream entities develop and implement efficient and compliant internal operations, prepare effectively for CMS audits and everything in between, with professional services and unmatched compliance tools.
PBM Audit
We can help your MA-PD or PDP develop and implement efficient and compliant internal operations and prepare effectively for CMS audits with unmatched compliance tools. Our broad array of services can assist you in audit remediation and implementation of best practices so that your team can spend its time on the things that will impact your audit results when a CMS audit comes.