RxEOB

Secure-defined role access provides health plan staff users the ability to run up-to-date reports and collaborate with analytic features driven from claims and data queries.

Available functionalities are web-driven and provide comprehensive, understandable, actionable data at your fingertips necessary to make informed, timely decisions regarding treatment, fiduciary oversight, and outcomes.

RxMonitor components include:

Plan Administrator:

Standard and custom reports addressing pharmacy benefit costs, utilization, prescribing patterns, claim information, etc.
Non-PHI inclusive for appropriate use and review by non-clinical staff
Reports run in real time
Data and reports presented online and immediately available
Ability to export reports for internal use

Care Manager:

Disease-state specific reports driven from instant pharmacy claims data
Custom filters and queries to identify appropriate population segments
Ability to mask PHI in reports if necessary or provide pass-through to member history when necessary
Member and population identification, tracking for disease management and other compliance programs
Proactive identification of high-risk patients or potential costly treatment scenarios

Member Services:

Shared member view provides accurate pricing, benefit information, previously sent letters and e-messages, and PA status for enhanced communication and understanding between CSR and the member
Health plan customer service and pharmacy help desk representatives can both have access
No interface change or re-training required after a change in PBM or web portal

Plan / Sales Modeling:

Effectively develop benefit models utilizing historical claims data, updated pricing information, assumptive changes in formulary, benefit components, drug-to-drug migrations and plan changes
Allow sales executives the ability to respond to employer group needs or develop more client-specific benefit plans
Effectively predict changes to formulary, benefit or plan design
Reduce consulting fees
Improve negotiating position with PBMs and manufacturers
Incorporate added efficiency to P&T committee meetings and proceedings

"With all these tools and many more functions available, RxEOB is most definitely a beneficial tool that my staff and I use on a regular basis."

Antonia K. Wells
Pharmacy Operations
Coordinator
Bluegrass Family Health