Health Intelligence Systems RxPERT Solutions

Pharmacy Claim Payment Verification

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About Us
Health Intelligence Systems, Inc. offers retail pharmacies, an automated billing, and reimbursement monitoring solution, designed to increase pharmacy revenues and profits by identifying all underpaid claims. 
 
Leadership Team:
 
R. Carl Heffner, Founder/CEO/Director
 
Mr. Heffner has served his entire working career following his passion, developing innovative technology solving both operational and administrative challenges faced by Retail Pharmacy Associates and Executives.

Prior, to incorporating Health Intelligence Systems in 2004, Mr. Heffner served in various Executive positions at Costco Wholesale and Eckerd Drug Company. Due to Mr. Heffner’s passion for innovation, research & development, and continuous business process reengineering, he was assigned to various liaison roles to communicate and negotiate between Pharmacy Business Executives and Information Technology Executives. Mr. Heffner would advocate and rank the pharmacy projects and secure capital resources needed from the Information Technology Department. Mr. Heffner then ensured successful business acceptance by directing the business requirements and design phases through a successful implementation. During his tenure at Costco and Eckerd, Mr. Heffner has implemented many strategic pharmacy business critical solutions, such as, electronic prescribing, drug information, aggregation systems, HIPAA Privacy Consent Management Systems, Centralizing Pharmacy Files, Designing Pharmacy Data Warehouse, Financial Reporting Systems, Chain Wide Electronic Prescription Transfers and Web Based Pharmacy Management Systems.

Mr. Heffner has been involved in many professional organizations, including:

Health Level Seven Organization (HL7)
Healthcare Information Management and Systems Society (HIMSS)
National Council for Prescription Drug Programs (NCPDP)
American Society of Health-System Pharmacists (ASHP)
National Association of Chain Drug Stores (NACDS)
Masters of Business (MBA) Association
Tampa Bay Technology Forum (TBTF)

Mr. Heffner holds a Bachelors of Science in Business Management and is currently pursuing a Masters of Business Administration at University of Tampa's John Sykes School of Business.
Company History

 

 

 

 

 

 

 

Health Intelligence Systems, Inc. (H.I.S.) is a privately held company founded in 2004 and headquartered in Clearwater, Florida with technical centers in Tampa.

H.I.S. was formed to develop a comprehensive solution to provide Retail Pharmacies with the tools necessary to optimize profit opportunities from “Third-Party Prescription Drug Sales”. 

 

  • The Company’s RxPERT™ product line provides a cost effective Software as a Service (SaaS) Model.
  • The RxPERT™ product line detects and reports claims payment variances and revenue opportunities. 

 

RxPERT™ product line
 
HIS offers a Web-based, Third-party Contract Management Solution designed so that pharmacies can consolidate, organize and administer all contracts for prescription drug programs (PDP) they participate with in a “paperless” environment.
 
All paper contract rules and terms are entered and associated to the Client who sponsor or manages the prescription drug program (PDP). The price terms, price lists and drug lists are imported and associated to the client, plan, or group within the plan hierarchy. Additionally, the system has a unique versioning control and tracking feature allowing for change notification or multi-year auditing if needed. This process re-engineers current business processes and strengthens a pharmacy's ability to tightly manage, control, and negotiate better terms.

Third-party Contracts terms become embedded rules in our database so all claims under that plan are edited under specific conditions that may only apply to that specific plan. We integrate your contract rules, price lists, drug lists into our proprietary “Electronic Contract management solution” and then determine all payment variances where expected paid is not equal to actual payment.

Payment variances have averaged 1% of the average total Prescription Cost . Payment variances result in underpayments, costing the pharmacy approximately Sixty-five Cents on each brand drug and Thirty-two Cents on each generic drug dispensed.