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Pharmacy Benefit Management

We understand that your goal is to improve pharmacy benefits and care to your customers.

PBMs are focused on benefit design to optimize prescribing patterns, increase affordability, ensure use of appropriate drugs and prevent waste—in full compliance of ever-changing state and federal mandates.

Accomplishing this is especially challenging with healthcare reform mandates and increasing regulatory scrutiny. That's why HMS solutions offer benefits in the areas of:

  • Improved claims adjudication while reducing claim rejects due to poor prescriber licensure data
  • 2010 CMS Medicare Part D Requirements
  • Compliance & Risk Mitigation
  • Cost Containment
  • Physician Outreach
  • Helpdesk Support
  • Pharmacy/Pharmacist Network Credentialing
  • State Level Reporting
MasterFile Individuals More than 1.4 Million prescribers, demographic and licensure Information. MasterFile Organizations An in-depth compilation of Healthcare Organizations to identify complex organization hierarchical relationships. MasterFile Affiliations Actionable insight into the complex relationships of practitioners to the organizations where they work.
Prescriber Eligibility A real-time system to reduce your go-forward risk of State, Federal, and Third-Party Payer non-compliance. Customer Data Integration CDI centralizes your disparate data and enables consolidation of disparate prescriber files to a central file structure. Provider Online Online access to every provider in the U.S., including secure and subscription based-with unlimited look-ups and help desk tool.
CompleteView A fully managed and hosted solution that delivers compliance grade prescriber data customized to your specifications.   
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