Data Collection Updates for RxDC Reporting

Optima Health continues to review the data requirements and reporting timelines under the Consolidated Appropriations Act (CAA).

We are on track to meet these deliverables according to the timelines and have determined there are different actions required for each funding type. Optima Health plans to file 2022 reference year data to CMS by the June 1, 2023 deadline on behalf of all of the following:

  • Fully Insured Small and Mid-Market, and Large Groups
  • Self-Funded and BusinessEDGE® groups: if the group intends to file on their own behalf, please contact their Optima Health representative by March 31, 2023.

No action is required on the part of the group or broker for the following commercial group plans; Fully Insured Small Group, Fully Insured Mid-Market, and BusinessEDGE®.

To complete the filing for Fully Insured and Self-Funded Large groups, we will require each group to supply additional information. In the coming weeks, these groups will receive an email with a link to complete an electronic form to collect the following data points:

Large Group Fully Insured

  • Average monthly percentage of premium paid by employee
  • Average monthly percentage of premium paid by employer

Large Group Self-Funded

  • Average monthly premium equivalent paid by employee
  • Average monthly premium equivalent paid by employer
  • Total monthly premium equivalent by plan by tier
  • Stop-loss premium if not administered by Optima Health

The form will be tailored to the group type and will only gather the required information needed to file the report on the group’s behalf. The due date to submit the form will be in the email with the link and will be no shorter than a two-week turnaround.

More details on the regulations and requirements can be found on the CMS RxDC website. We will continue to update our frequently asked questions on our website as additional information becomes available.

Please contact your Optima Health representative if you have questions.