About
Clinical Services
Our clinical pharmacy staff understand the needs of medical offices and patients.Reporting
In order to effectively manage you must have the ability to measure. All data points for the services we provide can be utilized to create reports to measure success.Timeliness
We pride ourselves on getting to work quickly on requests so patients get the medications they need as quickly as possible. We work days, nights and weekend to make sure patients needs are met.Perserverance
RXPA is no fair weather friend. Upon receipt of a denial for a request we will automatically appeal in accordance with PBM/insurance company procedures.About Us
Clinical Services
Reporting
Timeliness
Perserverance
Clinical Services
About us
Our clinical pharmacy staff understand the needs of medical offices and patients. With years of experience working within Pharmacy Benefit Managers and insurance companies, our clinical team is more than equipped to handle anything coverage determination request. Utilization management for pharmacy claims takes on many forms. Key to obtaining approvals is understanding what information PBM’s are looking for to grant approvals. Our staff reies on their experience to glean the necessary information from the patient record to obtain approvals. More information to the PBM is not always better. Additional information may inadvertently lead to a denial.
Reporting
Features
In order to effectively manage you must have the ability to measure. All data points for the services we provide can be utilized to create reports to measure success. We have a standard set of reports which can be used to track trends and monitor effectiveness. We can also create custom reports based on any variables of patient data.
Timeliness
About
We pride ourselves on getting to work quickly on requests so patients get the medications they need as quickly as possible. We work days, nights and weekend to make sure patients needs are met. Many pharmacy benefit managers have extended or even around the clock staff working on coverage determinations. Depending on the health plan there may be time limits put on the PBM for responses or deadlines for a decision to be made. If a deadline is approaching and they do not have all the information for approval this leads to a default denial. Our extended working hours means the PBM can get the information they need even when your medical office is closed. This will decrease default denials and improve your patients access to medication.
Perserverance
About
RXPA is no fair weather friend. Upon receipt of a denial for a request we will automatically appeal in accordance with PBM/insurance company procedures. Appeals and re-determination procedures vary depending on the health plan. Medicare and Medicaid plans will have a structured system, whereas commercial plans will have a more flexible system with less deadlines. No matter what type of health plan we are working with on behalf of your office we will follow the plans predetermined process and seek all avenues for an approval.
