Claim Activity Monitoring
All claim activity is monitored on a daily basis.
24/7 real-time visibility on all activity.
Proprietary software validates all claims against over 35 edit checks ensuring accuracy and providing alerts.
All exceptions are reviewed daily prior to processing for reporting and payment.
Alerts include new writing physicians, new dispensing pharmacy, over concentration of claim activity, high dollar claim activity, skewed cash vs insured mix, PA reject concentration, etc.
Proactive management of exceptions as need including contacting the pharmacy for clarification and manual reversal of a claim if needed.