Industry Solutions

Health Plans

Add more flexibility, scalability and efficiency within a stable, secure environment.

Nurse with stethoscope talking to an old man.

Healthcare is most effective when delivered locally via community hospitals, physicians, nurses, pharmacists and other healthcare professionals. The payer system has a higher probability of success when customizing care delivery reimbursement in coordination with community providers.

Cost containment becomes more manageable when such alignment is achieved. At the core of the concept of alignment and integration of care delivery resides accurate claims’ adjudication and information analysis, which drives appropriate diagnosis and subsequent care paths. The most proficient managers of patient care consider this approach. The new millennium has produced several innovations and improvements along with tools and service bureaus that help make better care a reality.

PharmPix has entered the world of Pharmacy Benefit Management to take it to a new level. Its OneArk™ Suite allows more flexibility, scalability and efficiency for users within a very secure environment, such as is required in today’s world of healthcare.

On top of our software, PharmPix has added key PBM components that are necessary for payers when they are managing beneficiaries. The entire suite of tools and services can be purchased individually or as a package. These services are available for smaller fully insured groups under health insurance companies, as well as, self-insured groups directly managing their pharmacy benefit.

  • Real-time claims adjudication with point-of-sale eligibility validation, online safety and managed care editing capabilities and coordination of benefits
  • Detailed claims reconciliation reporting
  • Member/Employee portal for retail pharmacy availability, formulary information and access to co-pay/plan design information
  • Retail pharmacy contracting R30 & R90 fills
  • Pharmacy call center and pharmacy audits.
  • Medication Therapy Management (MTM) capability at point of sale with a business rules processing engine (BRPS) for push notification via email and text messages
  • Mail service options
  • Specialty pharmacy options
  • Prior Authorization (both systemic & live clinical professionals)
  • Member services call center
  • Clinical program consulting, and Retrospective and Concurrent Drug Utilization Review (DUR)
  • Pharmacy and Therapeutics (P&T) Services
  • Manufacturer Rebate Contracting
  • Manufacturer rebate billing and modeling software