Pro Pharma Announces a Comprehensive Management Tool for Pharmacy Invoices

Pro Pharma’s Invoice Screens™ including Part D Workbook™ tracks all elements of Part D: every invoice monthly, quarterly, and yearly to ensure that clients are aware of Part D non-compliance in Claim Adjudication- almost as fast as it happens
Invoice Screening™
Invoice Screening™
CANOGA PARK, Calif. - Dec. 9, 2014 - PRLog -- Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consulting organization which focuses on data analytical expertise, announced today that it has updated and enhanced their Invoice Screens™ Product, including Pro Pharma’s Part D Workbook™.  This enhanced feature is now available to assist Health Plans, Self-Insured Employers, Unions and Trusts and Workers’ Compensation companies with the onerous manual Accounts Payable reviews of Health Plan, PBM and TPA invoices.  Pro Pharma’s 100% electronic methodologies perform weekly, biweekly, monthly or less frequently analyses/audits of all Pharmacy Claims Invoices.  This feature also encompasses True Out-of-Pocket Costs (TrOOP) validation and Medicare Part D.

“Pro Pharma helps organizations manage and comply with Medicaid and Medicare benefits as close to real time as possible; most specifically at the PBM invoice payment.  You don’t have to wait for reports from CMS, or Medicaid and Medicare audits to find out what’s wrong!” states Dr. Craig S. Stern, President of Pro Pharma Pharmaceutical Consultants, Inc. “Pro Pharma’s Invoice Screens™ audit all elements of eligibility, benefit compliance, claim validity and re-priced payment validation, pre-payment. This also includes compliance with JCode payments for Part B and Part D drugs using Pro Pharma’s JCode Calculator™.  In addition, Pro Pharma’s pre-payment analyses/audits cover MAC compliance with State Medicaid MAC and the federal FUL,” concludes Dr. Stern.

“Invoice Screening™ eliminates payment errors, identifies problems previously unidentified or historically not addressed; and puts money back in your organization’s pocket”, states Carol Stern, CEO.  She states further that “Pro Pharma assists clients in minimizing their Drug Spend by identifying savings opportunities not commonly addressed by the PBMs.  Pro Pharma will turnaround these reports timely to ensure management review, oversight, and action occur within seven (7) business days after receiving complete data sets.  This works to prevent payment rejections”.

Pro Pharma’s Suite of Management Tools™ ( can provide health plans with program information so that they can discuss cost savings options before State efficiency audits cause them to experience reduced capitation rates, with their Pharmacy Benefit Consultants and/or Pharmacy Benefit Managers (PBMs).  This includes:

-   Drug pricing consistent with the statutory definitions of AWP

-  Generic pricing consistent per-claim with Medicaid, Medi-Cal and Medicare rates

-  Claim validity checks before denials by the State or CMS

To achieve savings these options must be available at “point of invoice payment” so that Finance Departments can ensure compliance with State and Federal payment guidelines.  Essentially, the Accounts Payable Department, or function, must be able to analyze/audit pre-payment.  Using current technology - Invoice Screening™ - this is possible and is currently being performed in both public and private organizations and health plans.

Pro Pharma currently supplies Accounts Payable Departments with pre-payment pharmacy claims Invoice Screening™ that addresses all issues discussed above, and allows Organizations and Health Plans to make appropriate cost saving decisions.

888-701-5438 - Call today for a free one-on- one consultation with our Pharmacy Benefits Professionals who have over twenty-eight (28) years of experience.

About Pro Pharma Pharmaceutical Consultants, Inc.

PRO PHARMA is 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 Comprehensive Specialty Analyses™, JCode Calculator™, Invoice Screening ™, Pro Pharma Suite of Tools™, Rx MAC List™, Quality Management Program™, Treatment Calendar™, and Biotech Modeling™.  The Pro Pharma directly markets its products in the U.S. and collaborates with partners to reach international markets.

About Comprehensive Specialty Analyses™

Comprehensive Specialty Analyses™
utilizes a multi-pronged approach to analyze pharmacy and medical encounter claims through problem flagging, feedback on performance, peer to peer comparison, and others parameters. Comprehensive Specialty Analyses™ specifically identify pricing differences, usage, trends, and actionable opportunities in the medical data that were not apparent in the past.  In order to achieve these goals it is necessary to view the Medical Data from multiple perspectives, i.e., a 360 degree view that allows for seeing beyond the obvious of top drugs spend and top providers as well as compare and contrast it with the Pharmacy Claims Data.

About JCode Calculator™ (

Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payment.   The advantage to this product is that it bases all Injectable reimbursement on AWP, WAC and ASP cost, and can be customized for drug category discounts or multiple discounts based on drug type or specialty. It includes at least one AWP for every HCPS Code and CPT code description; NDC, brand name, generic name, strength, package size, etc.  This look-up reference tool provides non-pharmacist billing and claims personnel with the information and knowledge to process and reimburse claims in a timely, efficient and cost effective manner.

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”.

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.

Media Contact
Carol Stern, CEO
Pro Pharma Pharmaceutical Consultants, Inc. PRs
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