Successful pharmacy benefit management requires the ability to instantly adjudicate and edit claims, as well as manage benefit rules, clinical programs and formularies. To maximize operational and financial results, payers and retail pharmacies require specialized solutions to effectively manage pharmacy benefits.
Gaining real-time access to information is necessary to assist with managing relationships, decision making, development of best practices, as well as pharmacy claims adjudication and billing. With our solution, ProPBM, developed by RelayHealth Prospective Health Services, payers can manage all of their plans online, in real time, 24/7.
Our efficient and flexible solution gives payers real-time access to point-of-sale benefits claims, workers’ compensation claims, reimbursement, co-pays, patient medication histories, drug conflicts, membership eligibility data.
Copying and merging capabilities enable payers to simultaneously review and adjust formularies and other plan components for multiple plans. Payers can also reuse benefit components to quickly create new benefit plans.
With ProPBM payers can easily process, maintain and track information. Powerful reporting capabilities deliver information in the formats needed for effective decision support, and payers are empowered to manage their business and achieve their goals.
Using the right side navigation, explore our management solutions and resources for pharmacy benefit managers, or contact us if you have additional questions.