The Health Plan Connection
RxMonitor provides critical health plan functions with inter-departmental, targeted decision-support information through an extensive list of standard reports. Users can also create their own queries that can be added to a customized static report list.
An example of a few of these include:
Plan Administrator Module
RxEOB’s Administrator Module allows health plans to generate a series of standard and customized reports addressing pharmacy benefit cost and utilization. Reports produced in this module can provide clients (health plan or employer) access to important information without divulging any patient identifiable data.
Benefits include:
- Multiple standard reports
- Real-time data
- Data always online and available
- Data independent from PBM
- Drill down capabilities
- Accurate data compilation and reporting
- TrOOP reporting for Medicaid
- Oversight reporting for CMS and Medicare plans
Customer Service Module
RxEOB's Customer Service Module supports health plans in their efforts to provide superior customer service to their members and employers. The health plan's customer service representatives can now effectively manage all inquiries regarding the pharmacy benefit plan because of shared MyDrugBenefit view.
Benefits of the Customer Service Module include:
- Faster CSR response times
- More efficient CSR operations
- Increased client site utilization and member satisfaction with the health plan
Plan and Sales Modeling Module
RxEOB's Plan Modeling Module allows health plans to develop pharmacy benefit models using their own historical claims data. Based on a scenario driven approach, this module simultaneously models multiple benefit variables encompassing formulary changes, benefit plan changes, drug-to-drug migration/substitution assumptions, and new drug to market assumptions.
Benefits of the Plan Design Module include:
- Reduced administrative and operational costs
- Reduced consulting fees
- A more accurate prediction of the number of Members affected by plan changes
- Improved negotiating position with PBM and manufacturers
- P & T committee support
- Ability to demonstrate how employers can improve plan efficiency with changes to plan designs
- Ability for sales and marketing staff to demonstrate to employers how changing plan designs can impact their plan and their Members using the employer's own claim history
Care Manager Module
RxEOB's Care Manager Module allows the health plan's clinical support staff to quickly and easily identify high-risk patients by disease state and pharmacy claims data through customized filters. Managers can review patient specific information to monitor drug utilization and compliance with prescribed drug therapies. They can also conduct online research regarding available therapeutic options and related patient costs.
Benefits of the Clinical Support Module include:
- Reduced Rx plan costs
- Reduced health plan medical costs
- Improved Member compliance
- Earlier identification of high risk Members
- Improved communication with physicians
- Reduced operational and administrative costs
Data Manager Module
The Data Manager Module serves as a claim and history repository to help with formulary and benefit maintenance and design. The module allows staff to:
- Make real time changes to individual and group eligibility data hosted by RxEOB.
- Review the RxEOB data loads and view the results of RxEOB's comprehensive data integration and business rules checks.
The Eligibility Maintenance Utilities include access to update individual and group eligibility data using the Eligibility Maintenance link and Group Maintenance link respectively.
The Data Update Reports include access to three types of data loading reports. These data loading reports include Claims, Individual Eligibility and Group/Employer Eligibility.
Data Manager supports data QA procedures as well as HIPAA compliance procedures.
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