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TRICAST Debuts Part D Rejection Oversight Solution for Drug Plan Sponsors
Date:8/13/2012

MILWAUKEE, Aug. 13, 2012 /PRNewswire/ -- Recent civil money penalties levied by the Centers for Medicare & Medicaid Services (CMS) against a major Prescription Drug Plan (PDP) sponsor have hammered home the fact that CMS is not taking rejection analysis lightly. To help Medicare Advantage and stand-alone PDP sponsors respond to this new vigilance, TRICAST is offering a sound PBM oversight solution.

Primary Rejection Analytics

Rejection analysis and reporting is a crucial component of TRICAST's PBM oversight process. TRICAST reviews rejected Medicare Part D prescription transactions to ensure that plan management is aligned with appropriate plan design adherence. Their trained staff analyzes rejected prescription transactions to ensure that the six protected classes (Antidepressants, Antipsychotics, Anticonvulsants, Antiretroviral, Immunosuppressants, Anticancer) are not affected. TRICAST also analyzes and reports on rejected claims during a plan enrollee's transition period.

After a rejection analysis, TRICAST is able to determine if the majority of drugs were -- or were not -- covered. They also load and display all secondary messaging sent to the pharmacy provider to further support the oversight process.

TRICAST provides their analysis in reports that contain pivot tables, analyzing the type of reject by pharmacy and its timeframe. These pivot tables not only provide a breakdown of reason codes and a summary of the count of rejects, they also allow for actionable results, review, and resolution.

Complete Transition Patient Analysis

TRICAST loads all relevant eligibility to provide a complete third-party Transition Patient analysis. Inclusion of Transaction Reply Reports (TRR), Monthly Membership Reports (MMR) and Medicare Advantage and Prescription Drug (MARx) files the system portrays any patient experiencing a change in plan design, group or enrollment as "Transition." These patients will then have a separat
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SOURCE TRICAST, Inc.
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