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A Turnkey Solution for Plan Sponsors and PBMs.

Medicare Prescription Payment Plan Billing and Payment

The Medicare Prescription Payment Plan (M3P) burdens Plan D sponsors with a number of new billing requirements. Some sponsors have turned to their PBM for a solution while others have sought a solution on their own. PBMs have turned to vendors like Certifi because they lack the resources and experience to build their own solution.

Certifi can help. Our solution simplifies the M3P billing process. We offer configurable billing calculations to get you setup quickly, deliver clear and timely invoices, automated late payment and termination communications, and secure online payment options through an integrated payment portal.

Manage Medicare Prescription Payment Plan Billing With Ease.

M3P Billing Calculations

Certifi’s configurable billing rules ensure you calculate the first and subsequent month billing accurately based on incurred out-of-pocket prescription costs. Plus, our accounting design improves the accuracy of retroactive changes, like those necessary for LIS enrollees.

Configurable Invoices

Certifi’s configurable invoices simplify compliance with M3P invoice requirements, including the itemized out-of-pocket costs for each prescription for the billing month, the date, amount and means of the last payment made, the effective date of program participation and the additional language required by CMS’ guidance.

Payment Portal

Payment Management

Our payment portal simplifies payment management, enabling members to make a one-time payment, setup recurring payments and review payment and invoice history. Plus, our billing rules ensure payments are applied to premium bills first if the payment is unclear.

Delinquency Management

Delinquency Management

Our configurable delinquency management module triggers automatic M3P late payment and termination notices. Plus, the notices can be sent by email or mail, depending on the member’s preference.

Free eBook: Navigating the Medicare Prescription Payment Plan.

Implement In As Little As 90 Days

Medicare Prescription Payment Plan Implementation

Think you don’t have time to implement? Don’t worry. We can implement an M3P billing solution in as little as 90 days.

We have extensive experience building configurable billing solutions for health plans, private and public exchanges and benefits technology providers and follow a well-defined implementation project plan designed to build, test and release a solution unique to each client.

From requirements gathering to system configuration, from testing to training, we have the expertise and experience to ensure you are ready to bill for the Medicare Prescription Payment Plan in 2025.

Better Data = Improved Billing Accuracy

Whether it’s member eligibility data from the payer, M3P enrollment data from the payer or an enrollment vendor, claims data from the payer or PBM, or your general ledger for billing transactions, Certifi builds integrations with the key systems in the Medicare Prescription Payment Plan universe.

Why does it matter? By integrating with upstream and downstream data sources while validating all upstream data, Certifi is able to improve billing accuracy. Coupled with our Perfect Balance architecture, and you won’t find another solution as committed to billing accuracy.

Medicare Prescription Payment Plan Billing Accuracy

Certifi’s M3P Billing and Payment Solution

Certifi's M3P Billing and Payment Solution

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