Payment appeals
Medicare Part D plan sponsors may appeal program integrity prescription drug event record review audit determinations.
(a)Issues eligible for appeal.#
(a) Issues eligible for appeal. (1) CMS's application of Part D policy(ies).
(2) Factual or data errors.
(b)Issues ineligible for appeal.#
(b) Issues ineligible for appeal. (1) The Part D plan sponsor's failure to submit documentation in the timeframes specified by CMS during the audit.
(2) The program integrity prescription drug event record review audit methodology.