In the highly regulated space of Medicare Part D and clinical pharmacy management, compliance is everything. Our Coverage Determination and Prior Authorization services focus on assisting clients with understanding regulations and efficient operational processes, while eliminating the common violations associated with the CMS Coverage Determination, Appeals, Grievances (CDAG) audit findings. We offer critical guidance in maintaining cost-effective clinical services and mitigating substantial organizational risk.
With compliant processes in place and an evolving software application that keeps abreast of changing rules, HID helps plan sponsors navigate CDAG complexities while promoting a proactive approach to compliance.
The workflow process is application-driven, documenting audit-critical actions from end-to-end and steering the coverage determination process consistently.
Our Criteria Engine helps ensure that your CMS-approved criteria is administered in a compliant manner, increasing the accuracy and consistency of clinical decision making.
Member notifications are generated and stored entirely within the application, including recording and reporting of mail-stream entry time.
Our application has been built in a manner to audit all critical actions of each coverage determination request, documenting the date, time, and user for each action taken.
We’ve developed a thorough coverage determination process, software application, and clinical services team that will provide consistency and auditability to your program, increasing regulatory compliance and providing the means to better control your processes.