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This email is intended for producers with business in all markets and across all regions. VIDEO GUIDANCE - Rx REPORTING SURVEY COMPLETION FOR CONSOLIDATED APPROPRIATIONS ACT (CAA) Background Section 204 of the Consolidated Appropriations Act, 2021 (CAA) requires health insurance issuers and self-insured group health plans to submit information regarding prescription drug spending, health care spending, and enrollment each year to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. This information must be submitted in specific file formats to CMS for the 2022 calendar year by June 1, 2023.
New for the June 1, 2023 submission: Health insurance issuers and self-insured group health plans must report the actual premium amounts paid by the employer vs. the actual premium amounts paid by members in calendar year 2022. Like most health insurance issuers and TPAs, Highmark does not store this information in our systems. We are therefore deploying a survey, described below, in order to collect the required premium information from both ASO and fully insured clients.
For both fully-insured and self-insured clients, please note the premium information collected will be reported on an aggregated basis – premium details will not be broken out by individual clients.
In order to provide guidance for our Producer partners who are aiding in the completion of Highmark's Rx Reporting (CAA) surveys, several videos have been created. The goal of each video is to educate, guide, and help complete the survey Highmark is requiring.
Action Required by our Self-Insured Clients Please refer to this link for the video regarding ASO clients with Pharmacy carved-in while clicking here for the video around ASO Clients with Pharmacy carved-out.
ASO clients that would like Highmark to submit premium data to CMS on their behalf must submit all of the required information to Highmark by no later than Friday, April 21, 2023 via this survey.
If the client does not complete the survey by the deadline, they will be responsible for the submission of the premium data file, (D1), and corresponding plan file, (P2), directly to CMS. This is the same approach that Highmark followed last year with its ASO clients.
ASO clients with carved-out Rx benefits will need to work with their PBMs to submit the data files specific to the pharmacy benefit (D3 - D8). This is the same approach that was followed for the calendar year 2020 and 2021 submissions.
What About Fully-Insured Clients? The video created to provide aid and explanation for fully-insured clients submitting the survey can be found here.
All fully insured group health plan clients must submit two pieces of information. They are the total premium amounts paid by the employer, and the total premium amounts paid by members in calendar year 2022 by no later than Friday, April 21, 2023 via this survey.
Highmark will incorporate the premium information provided by fully insured clients into our aggregated report.
Action Needed by Producers with Small Group business As a reminder of our previous communication, please know Highmark's Small Group team will be communicating directly with Producers who manage Small Group clients. Instructions will be provided to Producers as to the steps needing to be taken in order to have clients submit the necessary information.
Actions Taken by Client Management It is also important to know our Client Management team has been advised of the format by which Rx Reporting is being conducted. They've been supplied with a client email template (found here) to help convey the survey needs and message to clients not in the Small Group market.
Questions Please contact your Highmark Client Manager with any questions. |
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Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association. Insurance or benefit administration may be provided by or through Highmark Inc. or one of its affiliated Blue companies. Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Inc. or certain of its affiliated Blue companies serve Blue Cross Blue Shield members in the 29 counties of western Pennsylvania, 13 counties in northeast Pennsylvania, the state of West Virginia plus Washington County, Ohio, and the entire state of Delaware. Highmark Blue Cross Blue Shield of Western New York is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Highmark Blue Shield of Northeastern New York (Highmark BSNENY) is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. |
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