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What We Can Do for You

Claims Adjudication

Highly Customizable Plan Designs

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Multi-layered Network Design

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Drug, Formulary and MAC Management
 

Parallel Adjudication

Real-Time Benefits

Member and Eligibility Tools

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Claims and Accumulators

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Data, Insights and Reporting

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Accounts Payable/Accounts Receivable

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3-Pronged Data Integration Approach (UI, API, DB)

Operations

Web-based with Intuitive UX/UI

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Screens Designed With the Support Teams in Mind 

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Automated File Loading and Transferring

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Customer 360 Call Assist

Financial Services

  • Fraud Waste and Abuse Monitoring

  • Accounts Payable/Accounts Receivable

  • Retail Network Rental

  • Underwriting Support

  • MAC Management

  • Rebate Management

  • Copay Assistance

  • PBM Consulting Services

Operational and Technical Services

  • Plan Design Services

  • Claim Routing Services

  • Customer 360 Call Assist

  • API Connectivity

  • TPA Connectivity – Eligibility and Accumulator Expertise

  • Member Portal

  • Claims Adjudication

Clinical Services

  • Mail and Specialty Pharmacy

  • Formulary Management

  • Clinical Pharmacists

  • Prior Authorization Criteria

  • Automated Prior Authorizations

  • CoverMyMeds and Surescripts

“The business of business is relationships; the business of the future is creating value through connectivity, cooperation, and co-creation.”

Nilofer Merchant

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