Manage Your Claims
Our benefits and pharmaceutical reports—an advanced claims and billing system licensed in NYS—eliminates costly payment and medical errors. Our reporting system checks for claims adjudication, or paying or declining pharmaceutical claims. Our report checks for medical errors, inappropriate prescribing, eligibility requirements, and deductible payments, and even healthcare fraud.
Ensure all your billing and claims are always processed accurately and correct productivity measures midstream with our innovative reporting tools. Access reporting services 24 hours a day/7 days a week.
Each client receives the personal attention of a pharmaceutical and benefits management expert, who will walk them through the process of developing a customized reporting plan.
CareRxSolutions offers various billing and claims reporting options such as:
Drug Utilization Review
First, an expert will review your existing utilization management review/conduct an analysis of your existing management plan and provide an oral report on estimated cost-savings with suggestions of ways to improve the plan. Access real-time pharmacy claims adjudication in real time or batch mode.
Based on the national requirements for all Pharmaceutical Benefits Management programs, CareRxSolutions provides clients with Drug Utilization Reviews which can be used before during and after a plan is implemented. Through implementing these authorized, structured, ongoing reviews of healthcare provider prescriptions, drugs dispensed by pharmacists, and patients’ use of medication, our clients can provide medication decision-making and positive patient outcomes.
*The purpose of the Office of the Medicaid Inspector General (OMIG) Compliance Audit is to prevent duplicated drug payments and hospice per diem amounts as well as determine whether payments are correct and supported by Medicare Part A and D.
Pharmaceutical and Benefits Claims
Claims summaries can be listed by:
- Compounded drugs
- Pharmacy network
- Physicians claims or profiles
- Formularies
- Reports membership payment preference (average cost and non-preferred?).
Track Trends
Our research reports provide benchmarking and trend information to help guide your decisions on drug benefit design and management.
Hospice Report Library
Access all your standard and custom reports by category, physician, patient or drug
Our tools make it easy to complete a OMIG Compliance Audit which includes CR8358 data requirements for hospice claims. Our standard formularies are designed to meet client objectives, whether it’s reducing costs or maximizing rebates. Learn how maximize rebates and receive 100 percent of all rebate monies.
Office of the Medicaid Inspector General (OMIG) Compliance Audit
CareRxSolutions offers an auditing tool to make it easier than ever to fulfill the Office of the Medicaid Inspector General (OMIG) Compliance Audit. Using our quarterly reports, clients can sleep soundly knowing all reports will demonstrate medication billing compliance for beneficiaries residing in their cong term care facilities.
Per the Office of Inspector General requirements under Medicare Part A for hospice benefits and Medicare Part B for drug coverage, Hospice must provide records of billing compliance for all services paid through Medicare funding.*
The audit includes the following:
- General inpatient (GIP) visit reporting for certain hospice-paid staff
- Facility National Provider Identifier (NPI) number when care provided is not at the hospice facility that is billing the care
- Review the appropriateness of drug claims for individuals receiving hospice benefits in Long Term Care facilities.
- Ensure medications related to the patient’s terminal illness are billed correctly.
- Provide hospice with reports demonstrating medication and billing compliance for hospice patients residing in the LTC facilities.
- Post mortem (PM) visit reporting.
- Reporting of infusion pumps and prescription drugs.