If your Employer Group Waiver Plan (EGWP) contracts directly, or indirectly, with the Centers for Medicare and Medicaid Services (CMS), you face multiple plan oversight and administration challenges. That’s why Caribou offers a host of services to assist you with these responsibilities, including:
- Review of CMS reporting, including Prescription Drug Event (PDE) data set against paid claims utilization to verify reporting accurately reflects client drug spend, with special attention to how the PBM handles non-Part D claims.
- Benefit administration review for compliance with CMS bid submission as well as plan sponsor limits, including member cost-share review, Wrap Plan coverage and copays, LICS copays, and TrOOP limits.
- Eligibility Audit including LICS level validation.
- Review of how the Part D plan administrator handles pass through of direct and low income cost share subsidies, low income premium subsidies, manufacturer gap discounts and reinsurance credits.
- Manufacturer rebate audits, including review of Direct and Indirect Remuneration (DIR) reported.
- Validation of processor corrective actions in response to CMS PDE audit findings.