Pro Pharma has developed this Standardized Injectable Fee Schedule to assist with management of claims payment of self injectables, vaccines, immunizations and cancer therapeutic agents.
Pro Pharma’s JCode Calculator™ Version-2 (http://propharmaconsultants.com/
“We have simplified the ordering process to make using this “time and money saving” tool easier to implement”, said Carol Stern, CEO of Pro Pharma. “We have enabled ordering to be accomplished off of our Pro Pharma Shopping Cart so that Billing and Claims Professionals can begin using the JCode Calculator™ immediately and on an “as-needed”
This Tool has been developed to enable anyone responsible for claims and billing payments and reimbursements ease of use. This includes, but is not limited to the following:
• Physician Practices;
• Managed Care Organizations, small or large;
• Health Plans;
• Self-Insured Employers;
• Public Entities.
This E-Commerce solution combines a full featured help desk and live web chat software integrated into one powerful support platform. This provides a seamless and easy way to start processing medical claims with easy-to-use step-by-step configuration process.
Pro Pharma (propharmaconsultants.com)
• Improved look up and History Functions;
• MMA Part B vs. Part D coverage;
• Differentiations between Brand & Generic Drugs;
• ICD-9 codes for Approved Diagnoses Identification;
• Expanded NDC lookups;
• Expected Package Quantity;
• Drug Alerts where appropriate.
This reference database also includes, but is not limited to:
• HCPCS Code (including A, J, Q and S Codes);
• Current Procedural Code (CPC, formerly CPT) for drugs;
• Average Wholesale Price (AWP**) by package and pricing unit;
• National Drug Code number (NDC);
• Average Sales Price (ASP);
• Brand Name;
• Generic Name;
• Package Size;
• WAC (Wholesale Acquisition Cost).
** Other cost bases, besides AWP are also available.
The JCode Calculator™ Training is included with each subscription for ALL new customers and ongoing training and education is available and provided by Dr. Craig Stern, President of Pro Pharma on a scheduled as needed basis.
About Pro Pharma Pharmaceutical Consultants, Inc.
PRO PHARMAis a multi-service, woman owned, privately held consulting firm offering a vast portfolio of services to public and private entities including self-insured employers, Taft Hartley Trusts and unions, public employers, for-profit hospitals and integrated health networks, health care insurance companies, worker's compensation insurers, small-to-medium sized HMO's, and physician groups.
As a primary service to plan sponsors for achieving below trend results, PRO PHARMA provides an integrated program of administrative process improvements, clinical quality oversight, and provider/member education.
Pro Pharma’s Consulting services are grounded in the use of data and the communication of that information to define benefit trends, drivers and other analytical indicators. PRO PHARMA markets Biotech Modeling™, Invoice Screening ™, JCode Calculator™, Quality Management Program™, Rx MAC List™, Treatment Calendar™, and Pro Pharma Suite of Tools™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Quality Management Program™ (QMP)
Pro Pharma’s Quality Management Program™ (QMP) is a multi-faceted approach that targets the pharmacy benefit cost and quality from multiple directions; namely, physician prescribing decisions, member demands, pharmacy oversight and patient education, HR rep education, and messaging to actives/retirees. The program is focused on providing patients and physicians specific tools designed to make more informed purchasing decisions that expand member co-pay dollars. The bottom line is: payers (self-insured, employers, Trusts, etc.) lower their pharmacy trend.
About Invoice Screening™
About 10% of drugs spend is being paid from PBM Invoices, and should have been rejected by clients prior to payment. Pro Pharma’s Invoice Screening™ analyzes invoices against: formulary compliance, compliance with MAC pricing, eligibility, claims pricing, invalid claims, and excluded benefits, pre-payment as an Accounts Payable function. This ensures that clients only pay for valid claims, which saves time and dollars in the long run.
About Biotech Modeling™
Pro Pharma utilizes both the Medical and Pharmacy paid claims to analyze previous claims experience and to develop a model to project future trends. These issues center on the need for drug specific claims information, processing rules to ensure accurate quantities and maximum payment amounts, and rules for processing miscellaneous claims. The model can be updated with enhancements expeditiously given new Medical and Pharmacy claims experience.
About Treatment Calendar™
Pro Pharma’s Treatment Calendar™ is a proprietary program comprised of Artificial Intelligence rule sets, which allow for quality and cost comparisons by peer-to peer, peer-to-best in class, peer to national norms, and peer to local norms.
About Rx MAC List™ (Pharmacy Maximum Allowable Cost™)
The Cost of Drugs is Skyrocketing. Pro Pharma develops and maintains customized MAC Lists for clients to help manage the effects of rapid and high increase of drug prices.
About Pro Pharma Suite of Tools™
Pro Pharma’s Suite of Tools identifies the cost and clinical issues for both Pharmacy and Medical, and formulates management plans and objectives to develop action plans to address “prescriptions for change”.
Please visit Pro Pharma website at www.propharmaconsultants.com for more complete information.