Rx Cost Savings Advocate

The system allows a third-party vendor to intercede on the transaction within the pharmacy claims adjudication process. These interventions are allowed during pre- and post-adjudication.

Third-party vendors can intervene on a transaction initially submitted by a pharmacy by suspending the transaction and submitting a rerouted transaction in its place based on obtaining a better price for the patient.

The intelligent system allows a third-party vendor to take action on a transaction without directly receiving the request. In this instance, the vendor shares with Optum their routing rules and Optum PPE makes the update to the BIN/PCN on the transaction.

Incorporating complex routing logic directly into the claims processing workflow automates manual processes for pharmacies, reduces unnecessary expenditures and saves time and resources.