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Solution

Rx Cost Savings Advocate

Our custom Rx claims routing solution reduces costs for patients, payers, PBMs and pharmacies by automating claims workflows.

Reduced pharmacy costs for a better healthcare system

Web services

Third-party web services

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.

Reroute transactions

Suspend and reroute transactions

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.

Intelligent routing

Processor intelligent routing

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.

Save time

Save time and resources

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

Key benefits

Simplify pharmacy claims routing

  • Increase medication adherence.
  • Reduce out-of-pocket price for patients.
  • Automate manual processes.
  • Reduce health plan and expenditures.
  • Enrich the patient experience.
  • Simplify the pharmacy claims routing system.

Intelligent claims processing

  • Obtain lowest prescription pricing.
  • Benefit from efficient third-party web service.
  • Suspend and reroute claims submissions.
  • Save time and resources. 

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