Claims Oversight Management

PRO PHARMA Pharmaceutical Consultants, Inc. is expert in design and oversight of Pharmacy benefits; utilizing sophisticated analyses of pharmacy, medical and related claims databases. PRO PHARMA's designs employ "out-of-the-box" solutions to deal with complicated labor/management situations. Oversight and management include the following:

• Design of Benefits
• Oversight of Benefits
• Trend Management
• Simulation of Benefits
• Gap Analysis
• Infrastructure Reporting

Increased management and oversight leads to decreased hassle and complications. Proactive management of the Pharmacy benefit puts you in the "driver's seat" for identification of opportunity savings and cost efficiencies. Pro Pharma has the tools and data sources to manage your benefits to put dollars back in your pocket.

Claims Oversight Managment Utilizes:

• Comprehnsive Specialty Anlysis
• Analyses Of Integrated Data Sets for Pricing, Quantities, and Regulations
• Customizable Maximum Allowable Cost List
• Build Your Own MAC With Complete Transparency
• Fraud, Waste & Abuse
• Continuous Monitoring Of FWA Targeted To Prevention And Modification Of Performance
• Invoice Screening
• Monthly Management Analyses Of Integrated Data Sets To Identify Outliers For Targeted Improvement
• JCode Calculator
• Specialty Medication Fee Schedule With Approved Diagnoses And Quantities
• Prior Authorization
• Compliance With FDA Approved Indications And Usage
• Request for Proposal Review
• Helps You Decide Organizational Priorities