Having a dedicated team of clinicians by your side enables you to confidently manage healthcare industry trends, regulation compliance and relationships within your provider and member community.
Our Retrospective Drug Utilization Review (RDUR) solution is a comprehensive toolkit that includes expert clinical services, extensive system capabilities and robust data analysis to help you identify drug use trends and care gaps in your program.
Our RDUR solution empowers clients to discover usage trends in their member populations, adjust prescribing behavior through provider intervention and ensures appropriate formulary management’
Our RxExplorer® application collects and processes data from pharmacy and medical claims and compares these findings against our sophisticated therapeutic criteria. This produces an enhanced database for analysis, clinical review, and intervention.
Without the ability to gather information about program effectiveness, agencies risk increased pharmacy cost and decreased quality of care. Our RDUR solution allows you to identify potential therapy gaps and guide your provider population in healthier prescribing practices.
As drug regimens become more complex, risky and expensive than ever, it’s crucial that pharmacy programs adopt smarter Prior Authorization (PA) systems. A fully-automated PA system allows you to quickly and objectively verify appropriate utilization — saving you time and money.
RxPert® is a fully-automated prior authorization adjudication system that receives medication coverage determination requests. RxPert® evaluates requests using all available pharmacy, medical and eligibility data, and returns results in a real-time, secure NCPDP P4 transaction — with no human interaction. In fact, response times average less than half a second.
RxPert® uses clinical expertise to make superior coverage decisions by leveraging secure, scalable technology. RxPert® has refined the PA process by:
By utilizing automated prior authorization processes, our clients can control appropriate therapy with auditable, consistent and objective rules.