HCIdea is ideal for healthcare claims submissions and processing, retrospective drug utilization review
(RDUR), encounter data reporting, fraud and abuse surveillance, reducing ePrescribing errors, general physician and prescriber information, as well as cleaning and enhancing existing healthcare data.
Blue Cross utilized a retrospective drug utilization review
program initiated by Prime Therapeutics, Inc.
These interventions include retrospective drug utilization review
, plan member education materials, pharmacy messaging, physician calling and clinical consulting to educate physicians about cost-effective prescribing.
Our acquisitions over the past two years have positioned Medi-Mail to better serve the needs of large third party payor organizations as our company offers an integrated pharmacy delivery system including a national network of retail pharmacies for acute care prescriptions, claims processing adjudication and retrospective drug utilization review
Medi-Mail offers an integrated pharmacy delivery system including a national network of retail pharmacies for acute care prescriptions, claims processing adjudication and retrospective drug utilization review
Payers are also driving participation in state prescription monitoring programs (PMPs), as well as prospective, concurrent, and retrospective Drug Utilization Reviews
to minimize the occurrence of inappropriate use of opioids and other addictive medications.
Conducting Retrospective Drug Utilization Reviews
and Clinical Intervention Programs
Most PBMs offer both prospective and retrospective drug utilization reviews
for their clients, but not all of these programs contain criteria that are sophisticated enough to identify prescription drug fraud or abuse.