Rx Quality Claims, LLC
The right presciption for controlled pharmacy expense!
Some of the errors we look for are:
· Duplicate paid claims – Duplicates can occur when the pharmacy does not get a returned paid claim immediately or the system times out and the pharmacy resubmits the claim. The processor system doesn’t always recognize the claim as a duplicate because the pharmacy may submit a new prescription number.
· Claims requiring prior authorization – You may require a prior authorization on a medication and if the medication has changed status or the system is not set up properly to identify that medication, it could be paid without clinical intervention. The same cause could be for medication with restricted quantity limits.
· Formulary tier placement – Medication you want your employees to pay at a higher cost share could be inadvertently set up at a lower cost share basis. Again, this could be due to human error or a change in a status of the medication that caused it to flip tiers.
· Coverage Exclusion Review – Medications you do not want covered at any cost share may be processing through the system. As I said previously, this could be due to human error or a change in a status of the medication.
· Plus Administration Cost review and much more.
Why choose Rx Quality Claims:
Rx Quality Claims, unlike many of our competitors, is paid on a contingency fee basis
We take a portion of the legitimate recoupable funds identified. With this process, the client is not out any additional money for an audit.
Rx Quality Claims tries to work with you and your benefit manager as a liaison to keep your relationship intact and productive.
Rx Quality Claims understands how difficult it is to find and implement a new benefit processor. We try to preserve the current relationship so you don’t have to change vendors.
We try to ascertain both the problem and the solution to minimize future risk.
We identify the incorrectly processed claims and then work with you and your benefit manager to find out why they were processed incorrectly.
You deserve the serenity of knowing your benefit processor has your best interest in mind. Rx Quality Claims will help you get that peace of mind.
We have built our company on a win-win concept to assist self-insured clients in saving money in these economic hard-times.
