Our proprietary software works as a semi-permeable membrane against bad claims. OneArk™ avoids waste and inaccuracies at the Point of Sale (POS) through the integrated application of clinical, administrative and market knowledge.
These are your most cost-effective tools to combat the increase in costs and utilization. It also helps to improve your services and CMS compliance through real-time tools that proactively resolve issues at the POS.
Check out some examples of how OneArk™ defends your finances:
Accurate duplicate therapy edits
OneArk™’s Exception Tool helps us eliminate inaccurate edits and/or messages to pharmacies through our Drug Utilization Review Program. Our duplicate therapy criteria are totally customizable based on P&T decisions. This way, real duplicate therapies are recommended as hard rejects.
Accurate claims quantities
Many drugs, because of their dosage form, or packaging, are more likely to be submitted by pharmacies in incorrect quantities (such as insulin, eye drops, enoxaparin and others), confusing strength in milligrams with milliliters. PharmPix has created a POS logic that effectively avoids these errors.
Drug pricing examples
Date of Service Based Adjudication Program: Branded drug prices increase once or twice a year and many pharmacies’ software are set up to reverse and then re-submit branded claims so that the claims can be adjudicated at the higher price. When processing the requested adjustment, PharmPix’s system looks for the date of service and adjudicates accordingly, resulting in a net $0 adjustment.
- POS (Point of Sale) alert system: A real-time alert queue keeps our clients aware of what’s going on at the POS and provides a tool to proactively manage prior authorizations.
- Client set up and management changes: OneArk™ Cube is a tool designed to set up a client and make changes to existent designs/formularies in just minutes.
CMS Compliance examples
- Real time CMS member transition program: OneArk™ EDI allows claims not otherwise covered by the plan (non-formulary drugs) in the transition period and creates an automatic letter that is sent to the member. The process at the POS is transparent for the member and compliant with CMS rules and regulations. A message is also sent to the pharmacy indicating that “this claim has been paid through the transition program, please provide counseling to the member”.
- CMS-protected categories: OneArk™ EDI allows claims edits, such as PA, in these categories only for new starts. When members come back for their medication, the system will not request a new PA because the system will detect that the member has been in this drug therapy before. This happens even if there is a new prescription for the drug in question. Our experience shows that all these tactics save from 0.5% to 1% of total pharmacy costs and provide 100% compliance with CMS rules.