RDS Reconciliation


As Plan Sponsors, who contract with the Centers for Medicare and Medicaid Services (CMS) to participate in the Retiree Drug Subsidy (RDS) program, you face multiple challenges in plan administration. These range from benefit plan attestation, eligibility maintenance, Rx vendor management, and oversight for final cost reporting to CMS.

Let Caribou help reduce the stress and take the guesswork out of final reconciliation to make your RDS program a success. Caribou’s expert Medicare Part D Pharmacy Claims Audit services will help guide you through fulfilling all of the oversight requirements outlined by CMS/RDS for submission of plan costs during final reconciliation.

  • Paid claims experience is tested against the CMS Retiree file and Caribou’s master drug file to ensure complete accuracy in cost data.
  • Caribou’s process maximizes subsidy dollars by verifying the final CMS retiree eligibility file against client and PBM eligibility records.
  • Caribou’s RDS system also includes a sophisticated reporting module that ensures CMS compliance for clients who engage more than one Rx vendor and may have members moving between vendors. Under these circumstances, coordination of costs are required as part of the final costs reported. Caribou’s tool has the option to generate main frame files in CMS’ standard reporting format for online submission to the RDS website by your vendors as needed.
  • Caribou’s process also generates a comprehensive electronic archive of supporting evidence of appropriate plan oversight in the event of a CMS audit.


  • Caribou’s robust RDS audit system (CRDx) reviews 100% of costs reported to validate final submissions.
  • All issues noted by Caribou’s expert analysts are reconciled directly with your Rx vendor to support a smooth reconciliation process free from surprises.
  • Caribou has audited millions of claims in preparation for final subsidy cost reporting deadlines and has never had a client miss their deadline.
  • Caribou’s pre-editing of eligibility has assisted clients in recouping hundreds of thousands of dollars in additional subsidies during final reconciliation.

For more information about how we can help your organization,