Regulatory focus

At Magellan Rx, having a sharp regulatory focus and our intensive knowledge of all things CMS comes first and foremost for our Medicare clients. We pride ourselves in being   experts in the fields of regulatory requirements, and our robust support programs help you rest easier at night.


Compliance oversight

Magellan Rx’s culture of compliance is the heart of our operations. Our Compliance program is overseen and operated by individuals with extensive Medicare, CMS and regulatory audit experience and established relationships with CMS. We are keenly focused on the full scope of compliance requirements, including:

  • Policies, procedures & standards of conduct
  • Compliance officer and compliance committee
  • Training & education
  • Prompt response to compliance Issues
  • Lines of communication
  • Fraud, waste & abuse
  • Well-publicized disciplinary standards
  • Routine monitoring & auditing
Audit support

Our 2021 CMS Audit for our Granite Alliance Insurance Company EGWP plan received a perfect score, validating Compliance Program Effectiveness (CPE), Formulary and Benefit Administration (FA), and Coverage Determinations, Appeals, and Grievances (CDAG).  We continue to strive for perfection with a client audit process that provides transparency and support and a track record that speaks for itself. We will be there every step of the way – from the moment we are informed of your audit, in meetings to discuss timing and deliverables, during the audit while inquiries and deliverables are requested, and during an audit debrief. Our dedicated audit team makes it easy for you to get the support you need during an inevitably stressful time.

CMS guidance

There are thousands of pages of laws, regulations and guidance that plans must navigate in order to stay current with CMS requirements. At Magellan Rx, it’s mission-critical that we provide cost-effective, compliant solutions to the new and emerging Medicare requirements. Our CMS guidance collaboration process takes the heavy burden off our clients to manage the guidance alone.

508 Compliance

Section 508 of the Rehabilitation Act requires government agencies to provide “equal or comparable access” of online information to disabled employees and members of the public. This means that websites, software and any documents posted online must be fully usable to people with disabilities. Not only is ensuring Medicare plan materials are 508 compliant the right thing to do for beneficiaries, failing to do so can result in fines and sanctions from CMS.

Magellan Rx takes 508 compliance seriously and ensures anything provided digitally to members passes strict 508 compliance checks. We believe that everyone should have accessible healthcare information at their fingertips.

Fraud, waste and abuse (FWA)

In addition to receiving continual CMS compliance and FWA training and education, Magellan Rx leverages our audit and reporting capabilities to minimize FWA for our clients. We perform onsite, desktop and claim review audits that target known Medicare FWA schemes, catching point-of-sale errors which results in client cost-savings. Additionally, our targeted reporting compares claim data to drug, pharmacy, and prescriber trends released by CMS. This allows us to support our clients with IMEDIC referrals and provide documentation to help plans enter data in the newly required HPMS fraud, waste and abuse portal.