Pro Pharma has developed this Standardized Injectable Fee Schedule to assist with management of claims payment of Self Injectables, Vaccines, Immunizations, Cancer Therapeutic Agents, and to now include Enteral Feeding.
“These new Enteral Feeding additions are popular amongst claims and billing professionals who utilize the JCode Calculator™ often via our Secured Web Access on a daily or weekly basis," said Craig Stern, PharmD, MBA, President of Pro Pharma. "I would like to thank our medical and reimbursement teams for their efforts, which led to this expansive update in this product line, which is specifically designed to help claims and billing professionals."
Pro Pharma provides secured Web access for Clients to the Pro Pharma secured website for quarterly updates and daily access and includes the following Key Features and Benefits:
• Pricing by Drug-Specific HCPSCS-CPT Codes
• NDC Codes
• Brand and Generic Names
• AWP, WAC, & ASP + 6% Pricing
• Strength and Package Size
• Pricing Per Package & Per Unit
• Therapeutic Category
• ICD-9 Diagnosis Flags
• Typical Dosage for Vaccines
• Purchase by Day/Week/Month/Quarter
• Customizable Discount Calculator
• Drug Alert Notifications
• Maximum Quantity Approvable Flags
Easy to use Functionality Includes, but is not limited to:
• Improved look up and History Functions
• MMA Part B vs. Part D coverage
• Differentiations between Brand & Generic Drugs
• ICD-9 codes for Approved Diagnoses Identification
• Expanded NDC lookups
• Expected Package Quantity
• Drug Alerts where appropriate
** Other cost bases, besides AWP are also available.
“The JCode Calculator™ is available on a daily, weekly, monthly and quarterly basis and can be purchased on the Pro Pharma Website. We are continuing to improve our product line by adding new futures and your input in invaluable to our mutual success.” said Carol Stern, CEO of Pro Pharma. “Call or email to schedule your online Demo today and get your one week free elevation.”
About Pro Pharma
Pro Pharma (propharmaconsultants.com) is a multi-service, woman owned, privately held consulting firm offering a vast portfolio of services to public and private entities including self-insured employers, Taft Hartley Trusts and unions, public employers, for-profit hospitals and integrated health networks, health care insurance companies, worker's compensation insurers, small-to-medium sized HMO's, and physician groups.
As a primary service to plan sponsors for achieving below trend results, PRO PHARMA provides an integrated program of administrative process improvements, clinical quality oversight, and provider/member education.
PRO PHARMA’s Consulting services are grounded in the use of data and the communication of that information to define benefit trends, drivers and other analytical indicators. PRO PHARMA markets Biotech Modeling™, Invoice Screening™, Quality Management Program™, and Treatment Calendar™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Enteral Feeding
Enteral feeding is the delivery of nutrients directly into the stomach, duodenum or jejunum, and is also called enteral nutrition. Enteral formulae can be (1) nutritionally complete, when given in the recommended amount, to be used as a sole source of nutrition or as a supplement to the patient’s normal intake, or (2) nutritionally incomplete, to be used as a supplement only and not as a sole source of nutrition. Supplementary oral intake of dietary food for special medical purposes in addition to the normal food. ONS are usually liquid but they are also available in other forms like powder.
Standard formulae are enteral formulae with a composition, which reflects the reference values for macro- and micro-nutrients for a healthy population. Most standard formulae contain whole protein, lipid in the form of long-chain triglycerides (LCT), and fiber. However, non-fiber containing formulae with otherwise similar composition also exist. Most standard formulae contain neither gluten nor lactose in clinically relevant amounts. The presence of gluten or lactose should clearly be mentioned on the label.
Disease-specific formulae include those with macro- and micronutrient compositions adapted to the needs of a specific disease and/or digestive or metabolic disorder.
Immune modulating formulae contain substrates to modulate (enhance or attenuate) immune functions. Synonyms used in literature: immunonutrition, immune-enhancing diets.
Other forms of enteral feeding products are Low-Normal and High Energy Formulae, High Protein Formulae, Whole Protein Formulae, Peptide-based Formulae, Free Amino Acid Formulae, High Lipid Formulae, High Monounsaturated Fatty Acid Formulae and Enriched Normal Food products.
About Quality Management Program™ (QMP)
Pro Pharma’s Quality Management Program™ (QMP) is a multi-faceted approach that targets the pharmacy benefit cost and quality from multiple directions; namely, physician prescribing decisions, member demands, pharmacy oversight and patient education, HR rep education, and messaging to actives/retirees. The program is focused on providing patients and physicians specific tools designed to make more informed purchasing decisions that expand member co-pay dollars. The bottom line is: payers (self-insured, employers, Trusts, etc.) lower their pharmacy trend.
About Invoice Screening™
About 10% of drug spend is being paid from PBM Invoices, and should have been rejected by clients prior to payment. Pro Pharma’s Invoice Screening™ analyzes invoices against: formulary compliance, compliance with MAC pricing, eligibility, claims pricing, invalid claims, and excluded benefits, pre-payment as an Accounts Payable function. This ensures that clients only pay for valid claims, which saves time and dollars in the long run.
About JCode Calculator™
Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payments. The advantage to this product is that it bases all Injectable reimbursement on AWP, WAC and ASP cost, and can be customized for drug category discounts or multiple discounts based on drug type or specialty. It includes at least one AWP for every HCPS Code and CPT code description; NDC, brand name, generic name, strength, package size, etc. This look-up reference tool provides non-pharmacist billing and claims personnel with the information and knowledge to process and reimburse claims in a timely, efficient and cost effective manner.
About Biotech Modeling™
Pro Pharma utilizes both the Medical and Pharmacy paid claims to analyze previous claims experience and to develop a model to project future trends. These issues center on the need for drug specific claims information, processing rules to ensure accurate quantities and maximum payment amounts, and rules for processing miscellaneous claims. The model can be updated with enhancements expeditiously given new Medical and Pharmacy claims experience.
Pro Pharma can identify immediate savings opportunities through re-modeling of claims processing procedures, and longer-term savings through technology assessment and utilization management. Additional research and analyses can be performed to determine the biotechnology drug driven costs in procedures, diagnostics, and provider time. It is expected that these adjunctive costs will represent an ever-larger portion of the ambulatory experience downstream.
About Treatment Calendar™
Pro Pharma’s Treatment Calendar™ is a proprietary program comprised of Artificial Intelligence rule sets, which allow for quality and cost comparisons by peer-to peer, peer-to-best in class, peer to national norms, and peer to local norms.
Please visit Pro Pharma Pharmaceutical Consultants, Inc. website for more complete information.