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Category Archives: PBMs

Project Management for Insurance & HealthCare

Posted on March 18, 2016 | Categories: Account Manager, Agency Systems, ALIP, Analytics, Change Management, Claims, Clinical Services, Consulting, Development Project Manager, Document Management, EMR / EHR, ePrescription, eRx, Health Insurance, HealthCare, HealthCare IT, Insurance IT, IT Services, Medicare, MLTC, Mobile Health, PACE, Payers, PBMs | Posted by: admin

Project Management for Insurance & HealthCare

 

  • Casualty Insurance
  • Health System
  • Hospital Care
  • Life & Annuity Insurance
  • Property Insurance
  • Physicians Group
  • Inpatient
  • Out-Patient
  • Emergency Room

 

PMI approved Project Management – Scope, Time and Cost

 

  • Change Request Management – identifies and develops strategy for changes in scope, schedule, and cost.
  • Communications Management – creates and manages communications with stakeholders providing relevant details for informing and decision making in status reporting.
  • Cost Management – develops, monitors, and assesses project budgets through the entire project life cycle providing full transparency to stakeholders.
  • Documentation Management – Creates appropriate project documentation. Effectively negotiates tradeoffs between scope, schedule, and budget
  • Communication Management – Excellent communication, interpersonal, Presentation and written skills.
  • Implementation and Transition Management – creates transition plan, identifies lessons learned, and applies the lessons learned to future projects.
  • Integration Management – identifies and manages project interdependencies.
  • Quality Management – identifies relevant quality standards and defines governance, communication, and quality processes across SDLC – Dev, QA and Prod stages
  • Resource Management – identifies appropriate staff, defines roles and responsibilities, develop project organization chart and governance structure.
  • Risk & Issue Management – identifies and creates mitigation plans for risks and issues. Utilizes available tools for identifying and tracking issues.
  • Schedule Management – creates, manages, and understands impacts to project scope, constraints, and schedule via MS Project Plan and CA – Clarity
  • Organizational Management – Ability to work well on cross functional project teams including IT and business subject matter experts

Call us for Project Management & Program Management

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Specialty Pharmacy Technology Solutions by Techcusp

Posted on November 29, 2014 | Categories: PBMs, Pharmacy Benefit Management (PBM) | Posted by: admin

Specialty Pharmacy Software Solutions by Techcusp

 
Specialty Pharmacy is our sweet spot thus we understand its workflows, IT, Software and Reporting needs quite well. Call or Write to us for Comprehensive Technology Solutions for:

 

  1. Software for Specialty Pharmacy
  2. Specialty Pharmacy Reporting Software (SPSS)
  3. Dashboard for Specialty Pharmacy
  4. PBM Audit Tool
  5. Contract Reporting
  6. Medication Theraphy Management
  7. Disease Management
  8. Mobile Apps

 

Specialty Rx Dashboard – Reports

 

Our Custom Software (Desktop) or Cloud Based HIPAA compliant Software (SPSS) will give you following or more reports

  • Eligible Person Compliance Reporting
  • Quarterly Biotech Reporting
  • Specialty Drug Compliance Reporting
  • Therapeutic Category Compliance Reporting
  • Utilization Reporting-Disease State ICD9 Code
  • Utilization Reporting-Prescriber Report
  • Utilization Reporting-Specialty Drug
  • Utilization Reporting-Therapeutic Category

 

About Techcusp

 

  

Contact us

 

 

 

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Medication Therapy Management Software (MTMS) by Techcusp.com

Posted on November 21, 2014 | Categories: HealthCare, Medicare, PBMs, Pharmacy Benefit Management (PBM), Tech Cusp, TechCusp.com | Posted by: admin

Medication Therapy Management Software (MTMS) by Techcusp.com

 

Techcusp (via Portal www.HealthAnalytical.com ) analyzed the whole process to understand the practices, implications and short-falls of the MTM processes in operation and taking guidance from the CMS requirements, a new optimized process for MTM Program was designed and implemented through proprietary MTM software called MTM System. This system is intended at optimizing therapeutic outcomes thus promoting safe and effective use of medications which can lead to overall reduction in health care expenditure both for the beneficiary as well as the PDP/PBM/Rx.

 

MTM – the Benefits

 

  • Optimize therapeutic outcomes for targeted beneficiaries through improved medication use by identifying/reporting and helping to resolving drug abuses
  • Reduces the risk of adverse events by identifying potential adverse drug events, reporting them to providers involved and help to avoid adverse events.
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)
  • Ability to identify and qualify patients for drug monitoring programs
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)
  • Reduces the risk of adverse events
  • Scripted interactive interventions based on established rules

 

MTM Software (MTMS) – Features

 

  • Automated calendaring of the assessment task based on drug or manufacturer criteria
  • Automated clinician assignment for additional patient evaluations activated by patient assessment answers
  • Automatically assign risk stratification to the patient based on assessment timing and questions
  • Business intelligence reporting tool for ad hoc and immediate reporting capability, along with canned reports
  • Capture complete patient history for assessment questions and answers
  • Real-time monitoring dashboard for proactive management approach
  • System based Drug conflicts avoidance approach – Algorithm driven automatic Identification of Drug conflicts like:

■Drug-Drug Interactions

■Therapeutic Duplications

■Drug-Allergy Interactions

■Drug-Disease Interactions

■Beers’ Alerts

■Adverse Drug Reactions

■Dosage/Compliance Alerts

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PBM Audit Software (PBMAS)

Posted on November 21, 2014 | Categories: Analytics, Apps, PBMs, Pharmacy Benefit Management (PBM) | Posted by: admin

PBM Audit Software (PBMAS)

 

The audit help turn data into knowledge to make more informed decisions. It empowers decision-makers with easy-to-use tools to deliver insightful cost savings solutions that improve member’s health.

 

The benefits of PBM/Rx Audit

 

  • to prevent fraud, waste & abuse (FWA)
  • to implement the most effective benefit structure
  • to streamline costs
  • to manage member health
  • to evaluates current pharmacy benefit performance
  • to benchmarks PBM data against industry averages
  • to identify areas of potential improvement and accountability
  • to audit Pharmacy claims data
  • to audit contract compliance & pricing
  • to audit benefit design and network construction
  • to provide in-depth analysis and reporting on prescription claims data
  • to identifying effective co-pay design

 

PBM Audit Software (PBMAS) Features

 

 

  • Automation – Move from Paper to seamless automation

 

  • Dashboard – Reports
    • Eligible Person Compliance Reporting
    • Quarterly Biotech Reporting
    • Specialty Drug Compliance Reporting
    • Therapeutic Category Compliance Reporting
    • Utilization Reporting-Disease State ICD9 Code
    • Utilization Reporting-Prescriber Report
    • Utilization Reporting-Specialty Drug
    • Utilization Reporting-Therapeutic Category

 

  • Compliance
    • Contract Management from PBM/Insurance Companies
      • Claims
        • Administration
          • Quantity
          • Dispensing Date
          • Dispensing Intervals
          • Prescriber eligibility & information
        • Adjudication
          • Paid or Denial
          • Generic utilization
          • Formulary
        • Dispensing
        • Controlled Substance
        • Compounding
        • State & Federal Laws
          • HIPAA
          • HITECH
        • Concurrent Daily Review Audits
          • Documentation
            • Prescription Order Copies
            • Physicians Note
          • Timeframes
          • Discrepancies
          • Appeals
        • Retrospective Audits
          • Desk-top Audit
            • 12 months claims data
            • Refill-too-soon
            • Potential erroneous billed quantities
          • In-Pharmacy Audits
            • Evidence of potential wrongdoing
            • Complaints
            • Qualitative or quantitative outliers (high position in the Pharmacy Network Ranking)
          • Investigational Audits
        • Fraud, Waste & Abuse (FWA)

 

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Specialty Pharmacy Reporting Software (SPRS) by Techcusp

Posted on November 21, 2014 | Categories: Analytics, Apps, PBMs, Software Development | Posted by: admin

Specialty Pharmacy Reporting Software (SPRS) by Techcusp

 

Specialty Pharmacy (Rx) has become highly specialized in its approach to providing personalized patient support services. Many offer patient-specific clinical programs that center on disease specific treatment and medication management.

Techcusp Rx Software solutions via HealthAnalytical.com are 100% web-based, leveraging cloud computing for scalability. Further, they are HIE ready and ICD10, 5010 and HIPAA complaint. SPRS workflow system allows for drug and care assessment programs to be performed, tracked & reported in a structured environment. SPRS offers patient specific clinical programs that center on medication management to improve patient drug adherence and clinical outcomes. Contractual reporting is created based on Carrier’s/PBM criteria.

 

How Techcusp can help?

 

As per your growing needs, we could custom build the following software.

  • Specialty Pharmacy Reporting Software (SPSS)
  • PBM Audit Software (PBMAS)
  • Medication Therapy Management (MTMS)
  • Disease Management System Software (DMSS)
  • 340B Audit & Reporting Software (340BARS)

 

Specialty Pharmacy Reporting Software (SPSS)

 

The Dashboard – Reports Produced by Techcusp SPSS

 

  1. Eligible Person Compliance Reporting
  2. Quarterly Biotech Reporting
  3. Specialty Drug Compliance Reporting
  4. Therapeutic Category Compliance Reporting
  5. Utilization Reporting-Disease State ICD9 Code
  6. Utilization Reporting-Prescriber Report
  7. Utilization Reporting-Specialty Drug
  8. Utilization Reporting-Therapeutic Category

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425 Washington Blvd.,
Jersey City, New Jersey 07302, USA

Phone: +1 201.258.4704
Fax: +1 201.604.3480
E-mail: Contact@TechCusp.com

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