Services

  • Electronic Claims Processing (including member submitted paper claims)
  • Retail Network Management Services, including national and custom local networks
  • Prior Authorization services
  • Appeals (initial determinations and 1st level)
  • Communication for formulary/benefit changes to members and physicians
  • Rebate Administration
  • Reporting and Information Analysis Solutions
  • Maximum Allowable Cost (MAC) Management
  • Medicare EGWP and RDS Solutions 
  • Fully Integrated Call Center and Help Desk
  • Member Communications and ID Cards
  • Member Web Portal
  • Client Web Portal
  • Drug Utilization Review
  • Clinical Services and Consulting
  • Formulary Management
  • Enrollment and Eligibility Management
  • Benefit Plan Design and Management
  • Diabetes Management
  • International Pharmacy Options