Are You Ready to Comply with 455? How the CMS Regulation Affects You.
A 2015 report estimates that approximately $60 billion of American tax money, or more than 10% of Medicare’s total budget, was lost to fraud, waste, abuse and improper payments in 2014.
Centers for Medicare and Medicaid Services’ (CMS) strategy for ridding the system of fraud has been to move away from a pay-and-chase system to a preventive model. Identifying high-risk providers on the front end is easier than tracking and unraveling complicated transactions on the back end.
To help reduce the risk of fraud, waste and abuse, CMS has established requirements for Medicaid programs to validate their networks. All Medicaid PBMs, especially Managed Medicaid PBMs, may bear the brunt of this risk assessment.
This webinar will explore the new CMS regulation, the impact on PBMs, and how PBMs can use data, analytics and advanced technology to be in compliance.
- Understand the scope of the 455 regulations as it relates to PBMs
- Explore the kinds of data available to screen and validate providers
- Evaluate data solutions to comply with 455 requirements and network validation
Bobbie Riley, RPh, Sr. Strategic Relationship Manager, LexisNexis Risk Solutions
Brian Eidex, Director, Strategic Solutions, LexisNexis Risk Solutions