By 2020, specialty drugs in the pipeline will comprise 25% of the projected overall pharmacy benefit growth.
Top specialty drug category driving spending in 2019-2020
With our consulting expertise, healthcare organizations can manage, optimize and transform their businesses to new, efficient business models.
- Network Development
- Provider Services
- Member Services
- Pre-authorization services based on CMS Local Coverage Determination and Insurance Medical Policies.
- Medical Necessity screening.
- For Specialty Pharmacy our clinical team will conduct a telephone interview with the patient to validate that the medication was administered as directed by
- Quality management and Outcomes (subjective and objective measures).
- Prepayment Reviews
- Post Payments Review and Recovery process
- Reimbursement Policy
- Claims audit
- Claims Processing
- Claims payment
- Benefits management
- Pre-existing benefit exclusion Management
We acknowledge that training is vital in any project success. That’s why we will train and guide thru the implementation process our client’s team members as part of our service.