ATLANTA--(BUSINESS WIRE)--RelayHealth, a leading provider of healthcare connectivity services, and its Prospective Health Services business unit, today announced the general availability of ProSMARTTM, the healthcare industry’s first on-demand pharmacy claims adjudication reporting solution for payers. Restat, the nation’s largest independent PBM (pharmacy benefits manager), will deploy ProSMART to ensure accurate member documentation, optimize adjudication rule configurations and provide superior customer service to retail pharmacies.
“ProSMART will give Restat instant access to comprehensive claims adjudication reports – the required information for fast and accurate resolution of pharmacy claims transaction queries. Until now, this instant access to claims adjudication reports was not available in the industry,” said John Bergan, chief operating officer of Restat. “As long-time customers of RelayHealth, we appreciate their continued commitment to the development of innovative, automated pharmacy benefits management tools that drive customer service improvements while achieving elusive time and cost savings.”
Payers typically spend hours in claims adjudication rules research while still risking incorrect assumptions due to incomplete adjudication information. With RelayHealth’s ProSMART, the latest addition to the ProPBM platform, payers can generate a step-by-step trail of the claims’ course through the ProPBMSM application, gaining immediate insight into the benefits and rules configurations that affect the final claims outcome for rapid pharmacy query resolution, as well as optimization of adjudication rule configurations.
“RelayHealth’s Prospective Health Services developed ProSMART to address the increasing complexities and frequent changes in pharmacy benefits management plans, including Medicare Part D claims,” said Jeff Felton, president of RelayHealth Pharmacy Solutions. “For example, when a pharmacist calls to ask why a patient’s co-pay didn’t apply to a given prescription, the payer customer service representative can quickly run a ProSMART claims adjudication report, resolving the pharmacy query in minutes – exceeding customer expectations while positively having an impact on payers’ bottom lines.”
RelayHealth Prospective Health Services is an integral part of RelayHealth Pharmacy Solutions. Prospective Health Services’ platform combines transaction processing and rule-driven clinical and business strategies with testing, reporting, and financial systems to deliver innovative benefit management solutions that bring reliable online, real-time transaction processing to payer organizations. The business unit primarily serves as an expert knowledge partner providing the information technologies and data tools that payer organizations need to provide members with premier, cost-effective, high-quality healthcare coverage. Prospective Health Services’ proprietary benefit management systems are in use throughout the country and internationally. Annually the systems manage pharmacy benefits for more than 100 million members, and process over 550 million transactions.
Visit RelayHealth Prospective Health Services booth #1014 at the Academy of Managed Care Pharmacy (AMCP) 23rd Annual Meeting & Showcase, Minneapolis Convention Center, Minneapolis, Minnesota, April 27-29, 2011.
About Restat
A member of the Dohmen family of companies, Restat simplifies the purchase and use of healthcare services through independent health benefits management. As the largest independent PBM, Restat has no ownership ties to drug manufacturers or distribution channels, making it uniquely positioned to provide customers with unbiased benefit management solutions. Today, more than 4,200 companies, ranging in size from the Fortune 50 to small managed care organizations, rely on Restat to manage the prescription benefit for more than 12.2 million people nationwide. To learn more, visit http://www.restat.com or call 800-926-5858.
About RelayHealth
RelayHealth, McKesson’s connectivity business, operates as a neutral partner in an open network environment, offering connectivity services and integration among all organizations, systems, and solutions. Its intelligent network is designed to streamline clinical, financial and administrative communication between patients, providers, pharmacies, pharmaceutical manufacturers, and financial institutions. RelayHealth works to accelerate the delivery of high-quality care and improve financial performance through solutions such as online consultation of physicians by patients, electronic prescribing, point-of-service pharmacy claims resolution by payers, pre-visit patient financial clearance by providers, and post-visit provider bill settlement by payers and patients. RelayHealth securely processes more than 12.8 billion financial and clinical transactions annually. For more information, call 888-743-8735, or visit our Web site at http://www.RelayHealth.com. Follow us on Twitter @RelayHealth or like RelayHealth on Facebook.