Services

Coverage Determinations and Appeals

Managed Care Med Solutions • Coral Gables, FL

  • Initial part D Coverage Determinations:
    • Review coverage determination clinical denials for accuracy
    • Review of coverage determination attempts and time frames to ensure compliance with Medicare standards
    • Review documentation of coverage determination denials

 

  • Level 1 Appeals or Redeterminations for part D Medications Service Offering from MCM Solutions:
    • MCM Solutions has a team of clinical pharmacists with experience in part D programs and coverage determinations.
    • We offer Level 1 Appeals or Redeterminations directly to Health Plans at a reduced rate as compared to typical PBM rates
      • Rates are usually 25-75% lower than PBM rates
    • Ability to integrate into Coverage Determinations PBM software and collaborate with internal team

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Coverage Determinations and Appeals

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