RxLogic Eases Claims Adjudication Technology Implementation for PBMs Adding New Business
Moving to a new pharmacy claims adjudication technology platform calls for coordination across client programs and the teams that administer them. A PBM adding new business may be ready to introduce a different system before it is ready to migrate existing groups.
RxLogic supports easy, rapid implementations through configurable conflict-free technology and flexible migration strategies, giving clients a choice in how much business they move and when.
RxLogic Connects Claims Processing with Existing Systems
RxLogic delivers a Software-as-a-Solution (SaaS) technology platform that executes workflows at scale. Using a shared API framework to connect with a client’s existing systems and partners, the independent technology platform can reduce the number of separate interfaces the client needs to build and maintain. For example, eligibility data can feed adjudication from the current system so coverage is checked when a claim is submitted.
During implementation, clients can also configure benefit and pricing rules within RxLogic’s operational workflows to establish how their programs will be administered once claims processing begins.
New Business Can Lead a Phased Migration
RxLogic can support a phased migration that begins with new business. A newly signed employer group can start on RxLogic while existing clients continue with their current processor, separating new-group onboarding from the conversion of established programs.
Existing groups can then move in agreed stages. Teams can apply what they learn from initial onboarding as they expand the rollout, with migration dates planned around the organization’s client commitments and available resources.
RxLogic can also support a single cutover, moving the agreed business on one coordinated date. This approach suits an organization prepared to complete program configuration and staff preparation across the migrating groups before a shared launch.
A Secondary Processor Can Support Continuity Planning
The 2024 Change Healthcare cyberattack disrupted pharmacy claims and payment systems, resulting in consequences that document why an alternate processor needs to be considered alongside the connections required to reach it.
RxLogic can be implemented as a secondary processing option while an organization retains its primary processor. For that arrangement to serve its purpose, clients should work with RxLogic and the relevant partners to keep eligibility and benefit rules current, establish a tested route that can carry claims during an outage and define who can activate the secondary system.
Client Experience Helps Establish What Implementation Requires
RxLogic is not a PBM and supports clients without competing for their business. We have referenceable clients who can discuss the implementation process, allowing a prospective customer to assess the experience against its own program complexity and staffing. Those discussions can address the work the client performed, the support RxLogic provided and what its team needed to learn before operating on the platform.
As one client stated:
“RxLogic has been a pleasure to work with since day one. The reliability, security and speed of their system is second to none. They have provided hands-on support during every process whether it be implementation, training new team members, or supporting a new software upgrade. They are rising stars in our book!” — Nick Opalich of HospiceChoice Rx
Contact RxLogic today to discuss your implementation requirements and request a client reference.