Services Directory: Pre- and Post-Edits
Automates critical elements of claim adjudication by providing actionable messages specific to each claim. It offers a web-based suite of reports regarding the use of PPE and offers Core PPE, including AWP comparisons; DAW appropriateness for multisource brands; U&C market comparisons; quantity/days’ supply; Medicare verifications; Drug Enforcement Administration (DEA) authentications; NDC validations; and quantity/package size and National Provider Identification (NPI) validations.
For more information, or to enroll, visit www.relayhealth.com.
eRx Network® (formerly Change Healthcare™)
Provides a real-time pre- and post-editing (PPE) solution that comprehensively improves the pharmacy’s third-party reimbursements and in-store productivity. It contains a series of edits that provide financial, administrative and legal compliance reviews on prescriptions prior to being sent and received from the processor and offers a Market Usual & Customary (U&C) feature that compares U&C pricing to area competitors, providing pharmacies with valuable information for evaluating their retail pricing. It features online reports in near real-time for easy business analysis.
For more information, or to enroll, visit www.erxnetwork.com.
PPE through QS/1
Evaluates prescription claims for omissions, errors and compliance with industry standards and metrics, reduces third-party rejections, maximizes reimbursements and expedites payments and offers web-based reports that can be downloaded in a spreadsheet to illustrate where prescription edits are providing the greatest profit.
For more information, or to enroll, email firstname.lastname@example.org or call 800.845.7558, ext. 1424.