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Written by / Agency / Source: Pro Pharma Pharmaceutical Consultants, Inc.

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Pro Pharma Announces Specialty Services Portfolio - Pro Pharma is announcing Comprehensive Specialty Audits (Including Medical and Pharmacy Claims) now available to Self-Insured Employers, Health Plans, Unions and Trust Benefit Managers - ProPharmaConsultants.com
Pro Pharma Announces Specialty Services Portfolio

 

NewswireToday - /newswire/ - Northridge, CA, United States, 2013/03/04 - Pro Pharma is announcing Comprehensive Specialty Audits (Including Medical and Pharmacy Claims) now available to Self-Insured Employers, Health Plans, Unions and Trust Benefit Managers - ProPharmaConsultants.com.

   
 
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Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consulting organization which focuses on data analytical expertise, announced today that it has released their updated Comprehensive Specialty Audit Portfolio.

This Comprehensive Specialty Claims Audit (includes medical and pharmacy claims) is comprised of the following key components:

• JCode-Medical Claim Summary by JCode Drug Spend to summarize the claims, paid amounts, quantities and average utilization statistics for each JCode drug in the medical encounter claims
• Top 1000 Individual Medical JCode Claims by Amount Paid to show the detail of the 1000 most expensive individual JCode claims from the medical data
• JCode Claims with Quantities Exceeding Maximum Quantity for NDC which shows the detail of individual JCode claims from the medical encounter data where the quantity in the claim exceeds the maximum allowed quantity for the NDC for that particular drug.
• JCode Summary of Total Amount Paid by Provider which is an accounting for JCode drugs by each medical provider. This is based on all JCode claims from the medical encounter data, and ordered from high to low in expenditure. Details include the place of service for the claim, as well as the most expensive drugs prescribed by the provider.
• JCode Potential Savings shows potential savings if individual JCode claims in the medical encounter data had been priced correctly according to contract agreements
• Specialty Drug Summary From Pharmacy Claims by NDC
• Top 1000 Specialty Drugs From Individual Pharmacy Claims by Ingredient Cost
• Pharmacy Claims-Quantity Dispensed Exceeds Maximum Quantity for JCode (excludes solutions, suspensions and nebulizers)
• Pharmacy Claims Re-Priced According to Contracts
• Comparison of Amount Paid and Discounts Between Pharmacy and Medical Encounter Claims
• Identification of Any Claims Paid For Same Patient in Both Pharmacy and Medical Encounter Files
• Individual Pharmacy Claims Without Supporting Diagnoses (matched to medical data by data range specified by Client)
• Comparison of Quantity, Days Supply and Package Size (e.g. PBM Retail Specialty and Medical) to identify opportunities for improvement with pricing.

The Comprehensive Specialty Audits also analyze Medical Encounter and Pharmacy claims for:
• Claim Validity
• Pricing Validation
• Utilization vs. Product Labeling
• Usage Validation vs. FDA or National Standards
• Comparison of Pricing
• Duplicate Payments
• Location of Service Pricing and Usage Comparisons
• Comparison of Provider Cost / Usage for Same Diagnoses.

In conclusion, the Comprehensive Specialty Audit is expected to identify:
• Claims Paid at variance from contracts
• Claims Triaged to the “pend” or prior authorization files
• Claims for Referral to Medical Management
• Outlier Providers requiring interventions
• Medications paid at more favorable prices by specialty provider type
• Elements of Claims Payment requiring improvement
• Rule-Based Pricing Variations in pharmacy claims
• Duplicate Payments at pharmacy and at medical.

Please contact Pro Pharma for more detailed information.

 
 
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Written by / Agency / Source: Pro Pharma Pharmaceutical Consultants, Inc.

 
 

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Pro Pharma Announces Specialty Services Portfolio

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Pro Pharma |
Publisher Contact: Carol Stern - ProPharmaConsultants.com 
818-701-5438 carol.stern[.]propharmaconsultants.com
 
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