Data Aggregation Services

Data aggregation has been identified by Health & Human Service (“HHS”), the agency governing the ERRP, as a key step in the subsidy recovery process.  They have made it very clear that a Plan Sponsor must have a single party collect and aggregate data.  This forces Plan Sponsors to create internal systems to manage and track claim totals, cost thresholds, cost excesses, cost exclusions (Non-Medicare claims and Part D drugs) and member eligibility. Some insurance companies are building that capability; however, most are doing so for their claim and member data only. If other medical, drug or third party administrators are involved, a central data aggregator will be necessary in order to report cost summary data under ERRP.  Prior to the launch of the ERRP, RDS Services prepared itself to manage the program in it’s entirety, including the data aggregation.

Data Aggregation Services Include:

• Development, Implementation and Testing of Vendor Specific Data Mapping
  (technical architecture and design for client specifications)
• Design, Testing and Implementation of Data Format to fit ERRP guidelines
• Import / export functionality
• Medical/Rx claim aggregation and submission
• Create CPT/NDC Claim “Exclusion” tables
• Incurred Claim tracking and “adjustment” tracking over multiple plan years
• Data transfer secured via media or electronic tunnel
• Data import, sorts and conversions via complex logic
• Updating and maintenance of various beneficiary status information
• Develop threshold tracking logic for subscriber/members, including multi-source aggregation
• Identify reinsurance claim reimbursement potential for submission to HHS
• Confirm Medicare status of early retirees entitled to reimbursement
• Conduct reconciliation of claims submitted to HHS and reinsurance payments received for each plan year