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Tag Archives: PBM

ePrescription Implementation by Techcusp.com

Posted on February 6, 2015 | Categories: ePrescription | Posted by: admin

ePrescription Implementation by Techcusp.com

 

We are IT Services & Software Development firm based out of Jersey City, NJ.  Our ePrescription Implementation Project Managers have deep exposure & understanding of Acute/Ambulatory care, retail clinic, IPA, PBMs and long term care environment.  Reach out to us for our seasoned & domain rich IT Consultants; Developers & Software Engineers for short-term or long term Projects on FTE/W2/C2C basis.

 

 

Electronic prescribing or e-prescribing (e-Rx) is the computer-based electronic generation, transmission and filling of a medical prescription. Electronic prescribing (e-Prescribing or eRx) is a fast, efficient way to write/re-order and transmit prescriptions. e-Rx has pre-set fields so all the required information for prescriptions are entered and automatically stored in the patient’s record for easy review during follow-up visits or for transitions to other providers. An endeavor to replace Paper Prescriptions issued by Doctors and Physicians.  E-prescribing allows a new prescription or renewal authorization to a community or mail-order pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. As per CMS data of 2014, more than 40 percent of all permissible prescriptions written by the eligible professional are transmitted electronically using certified EHR technology.

 

ePrescription Benefits

 

  • Allowing greater prescriber mobility
  • Automating the prescription renewal request and authorization process
  • Improving formulary adherence permits lower cost drug substitutions
  • Improving patient safety and quality of care
  • Increasing patient convenience and medication compliance
  • Reducing time spent faxing prescriptions to pharmacies
  • Reducing time spent on phone calls and call-backs to pharmacies

 

ePrescription Stake Holders

 

  • Prescriber – Doctor or Physicians
  • Remitter – Physicians, Nurse practitioner, Physician assistant, clinician or health care staff
  • Tools (Apps) – Tablets, Smart Phone, Portal, Web, EMR/EHR
  • PBMs – Eligibility, Formulary & Medication History
  • Pharmacy – Prescription Data & Prescription Fill Data
  • ePrescription Gateway / Hub – The transaction hub provides the common link between all actors (prescriber, pharmacy benefit manager, and pharmacy). It stores and maintains a master patient index for quick access to their medical information as well as a list of pharmacies

 

 

Project challenges of electronic prescribing

 

 

  • To generate and transmit permissible prescriptions electronically (eRx)
  • To maintain Standards viz. HL7, NCPDP Script, and x12
  • To integrate with ePrescription Gateway Module
  • To ensure that PBM and transaction hub work seamlessly
  • To achieve connectivity and certification faster with less cost
  • To interact with defined web services
  • To perform the data load services required to process the large formulary data files

 

 

e-prescribing system- Features  & Project Modules

 

 

  • eServer- to perform all of the formulary, history, and Superscripts reporting requirements by generating and interpreting proprietary XML, flat file formats and X12 messages into a consistent well defined XML format
  • eScripit or Superscripts
  • EDI / Connectivity
  • Gateway / Hub Integration
  • PBM Integration
  • HER/EMR Integration
  • Eligibility Status
  • Medication History
  • New Prescription
  • RxFill & Renewal
  • Change Request
  • Cancel Request
  • Prescriber Registration
  • Formulary Load
  • Pharmacy Directory
  • Formulary Display
  • Pharmacy Search
  • Dashboard – Reports
  • Activity Report

 

 

Soft Skills

 

 

  • Demonstrated ability to understand industry issues and problems, relate them to clients’ needs, and propose appropriate solutions
  • Excellent interpersonal, verbal communication and presentation skills
  • Excellent project management skills and ability to manage multiple projects independently
  • Manage expectations of deliverables and timing
  • Possess supervisory skills and the ability to work on multiple projects.
  • Proficiency with Microsoft Office suite (Excel, PowerPoint, Word, Outlook)
  • Very Good communication skills – Interact with Project team and Business Representatives to understand the scope and purpose of the business process work stream

 

Why Techcusp?

 

  • American Firm
  • Attractive Pricing
  • Cutting-edge Technology Consultants
  • Deep Domain knowledge
  • Onshore/Offshore Delivery for scale & quality

 

 

To Hire Me Now! Contact – Careers with Techcusp.com  or

 

Dr Aradhana Khandekar

Partner – Consulting & Staffing

aradhana@techcusp.com

+1 914-703-1762 / 201.604.3480

www.TechCusp.com

Insurance IT | HealthCare IT | Banking IT | Staffing

 

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BPM Consultants by Techcusp.com

Posted on February 4, 2015 | Categories: BPM | Posted by: admin

Appian / Pega BPM Consultants by Techcusp.com

 

We are IT Services & Software Development firm based out of Jersey City, NJ.  Our Appian / Pega BPM Consultants have deep exposure & understanding of Insurance IT, HealthCare IT and Banking IT space. Reach out to us for our seasoned & domain rich IT Consultants; Developers & Software Engineers for short-term or long term Projects on FTE/W2/C2C basis.

 

 

Hard Skills

 

  • Business Process Management (BPM) Platforms – Appian, Pega, IMB Lombardi
  • Industry focus – Insurance & HealthCare

 

In the Insurance Space, Project Management on BPM Platform delivered for

 

  • Agency / Sales / Portal
  • Underwriting
  • Policy Admin (PAS)
  • Claims
  • Fraud & Abuse (F&A)
  • Compliance

 

In the HealthCare space, Project Management on BPM Platform was delivered  for

 

  • Patient Portal
  • Case Management (Care Management & Clinical Services)
  • Records Management
  • Compliance

 

 

 

Soft Skills

 

  • Demonstrated ability to understand industry issues and problems, relate them to clients’ needs, and propose appropriate solutions
  • Excellent interpersonal, verbal communication and presentation skills
  • Excellent project management skills and ability to manage multiple projects independently
  • Manage expectations of deliverables and timing
  • Possess supervisory skills and the ability to work on multiple projects.
  • Proficiency with Microsoft Office suite (Excel, PowerPoint, Word, Outlook)
  • Very Good communication skills – Interact with Project team and Business Representatives to understand the scope and purpose of the business process work stream

 

Why Techcusp?

 

  • American Firm
  • Attractive Pricing
  • Cutting-edge Technology Consultants
  • Deep Domain knowledge
  • Onshore/Offshore Delivery for scale & quality

 

 

Contact – Careers with Techcusp.com  or

 

Dr Aradhana Khandekar

Partner – Consulting & Staffing

aradhana@techcusp.com

+1 914-703-1762 / 201.604.3480

www.TechCusp.com

Insurance IT | HealthCare IT | Banking IT | Staffing

 

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Pharmacy Benefit Management (PBM) Software by Tech Cusp

Posted on December 7, 2014 | Categories: Apps, Pharmacy Benefit Management (PBM), Tech Cusp, TechCusp.com, Technology Stacks | Posted by: admin

Pharmacy Benefit Management (PBM) Software by Tech Cusp

 

 

We are custom Pharmacy Benefit Management (PBM) Software Company based out of Jersey City, NJ. We never look at projects and implementations in a vacuum, but consults with clients to make sure it fits in with their overall strategic vision. We will custom build your PBM Software to cover DISPENSING, TRACKING, BILLING, AND REPORTING. The provided software can interface with the EHR/EMR/Care Management or Disease Management systems. Our ground-up or enterprise software will be able to successfully automate dispensing, tracking, reporting, accounts receivable, claims reconciliation and claims adjudication for all medications dispensed. The information management system permits signature capture, pill imaging, bar code, Price Updates, Clinical Database updates and access to web server for daily medication price updates and real-time drug database updates.

 

 PBM Software Features to be custom built by Tech Cusp

 

PBM Reports

 

  • Adjustment to Sales
  • drug expiration
  • drug recall
  • drug tracking
  • drug utilization
  • drug utilization by payer type
  • drugs – daily usage
  • drugs – top selling
  • drugs not updated
  • generic exception
  • inventory control listing
  • non-billed Rx doctor drug- monitoring
  • patient third party list
  • price (special) print-out
  • price update report by date
  • print alpha patient profiles
  • Productivity
  • Rx cash audit

 

PBM End of Day Reports

 

  • class II log
  • controlled substance log
  • controlled substance refill log
  • daily backup
  • daily Rx log
  • ECS register
  • NDC index create program
  • non-controlled refill report
  • rebilled Rx log
  • Rx cash audit

 

Maintenance and Support (AMC) – Warranty; Training; Source Code

 

 

  • Maintenance and support will be furnished on a “turnkey” basis – i.e. contractually responsible for all maintenance and support services for all elements of the System, including but not limited to all software and any data transport services that are mentioned under the contract (MSA/SOW), and will be the single point of contact for service and support
  • Per MSA/ SOW, the user training and other training services will be provided
  • Per MSA/SOW we will deliver and ownership of the source code to the client, including complete documentation and specifications
  • The Client can expect that source code, including complete documentation and specifications, will be deposited in escrow, at no expense to the Client and on terms satisfactory to the Client, with regular updates of the deposited code and documentation to reflect enhancements, upgrades, updates, and corrections to the software
  • The warranty covers the entire System, including all software, other deliverables, design, implementation/integration and other services required under the Contract

 

 

Why Techcusp.com?

 

  • Deep Domain Knowledge
  • Agile Development Methodology
  • Competitive Pricing
  • Onshore/Offshore Development
  • Quality Delivery

 

About Techcusp

 

 

 

 

Contact us 

 

Mihir Desai

Partner

mihir@techcusp.com

Phone: +1 201.258.4704 / +1 646.479.9539

www.TechCusp.com

Insurance IT|HealthCare IT|Banking IT

 

Potential Candidates, leave your resume here – http://www.techcusp.com/get-a-quote.php

Potential Clients, Leave your requirements here – http://www.techcusp.com/get-a-quote.php

 

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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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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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Our Location

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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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