Revenue, Billing and Prescription Drug Event Management for Part D

Available in one or two modules: Premium Management and Activity Management. Best in class system to manage MA-PD and PDP revenue, member premium billing, PDE claims management, COB and TrOOP. The system can be configured to meet your unique needs by utilizing the individual modules or a combination of the two.

DTraq Premium Management Key Features

  • Monthly tracking and reconciliation of all member level payment characteristics including:
    - RxHCC
    - Age
    - Sex
    - Enrollment Status
    - Long Term Institutional
    - Low Income
    - Previously Disabled
    - Contract/PBP
  • Low income co-pay level and subsidy level tracking and reconciliation
  • Data sharing with Activity Management module or use PDE data if the Activity Management module is not utilized

DTraq Accounting Management Key Features

  • Financial reconciliation of monthly CMS Part D payment
  • Complete member level revenue and receivable calculations for:
    - Low income cost sharing
    - Low income premium subsidy
    - Reinsurance receivable
    - Risk sharing receivable
  • Member premium income and receivable
  • Revenue forecasting and variance analysis

Activity Management Key Features

  • Creates PDE record and submission, and handles error resolution and resubmission
  • Provides comprehensive COB management
  • Handles adjustments and deletions to PDE
  • Tracks TrOOP including data from CMS TrOOP facilitator and provides data for member statements
  • Prepares Employer Group Subsidy files

DTraq Member Premium Billing Key Features

A detailed, comprehensive system which handles all aspects of member and group premium billing including:

  • Customized member and group premium billings
  • Retroactive adjustments for changes in:
    - Enrollment Status
    - LIPS
    - PBP
    - Group Coverage
    - SPAP Coverage
    - SSA, OPM, RRB collections
  • Application of cash at member and group level
  • Generation of delinquency notices and follow up