Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consultant organization which focuses on data analytical expertise, announced today that Professor Dr. Craig Stern and CEO Carol Stern are currently attending the 25th Annual Western Claims Conference in Indian Wells, California.
Dr. Craig Stern converses with attendees and answers all questions from Claims professionals in all areas of health, life, and disability claim administration. Later today he makes two presentations:
- “Specialty Injectables… How to Solve Payment Problems” (J Code Calculator™)
- “Rebates… Through the Looking Glass” (Invoice Screening™)
“Review of biweekly PBM Pharmacy Invoices for Preadjudication Claims can save you 10-15%", said Craig Stern, PharmD, MBA, President of Pro Pharma Pharmaceutical Consultants, Inc. “Savings for most clients are realized when Pharmacy Invoice Amounts are verified and Billing Details are screened against Formulary Compliance, Eligibility, Pricing/Mac Compliance, Invalid Claims and Excluded Benefits. Oversight and Management of Vendor Claims Adjudication “real time” puts control back into your pocket.”
To get audio and video presentations of Dr. Craig Stern’s speeches please visit website or contact Carol Stern.
About Pro Pharma Pharmaceutical Consultants, Inc.
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 Invoice Screening™, Biotech Modeling™, JCode Calculator™, 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 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.
About Quality Management Program™ (QMP)
The QMP is a multi-faceted approach that attacks 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 directed to giving patients and physicians the tools to make better purchasing decisions that expand member co-pay dollars. The bottom line is: payers (self-insured, employers, Trusts, etc.) lower their pharmacy trend.
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 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.