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CONTRACT MANAGEMENT SOLUTIONS

Pharmacy Administration Solutions

Technology and Cash Management

Third-party payment optimization management is necessary to survive in today's retail pharmacy market. You have tighten the management so that each transaction is quickly audited the billing of transactions in a timely so you can realize cash more quickly. The margins in today's retail pharmacy industry are not what they were 10 years ago. The days of Average Wholesale Price PLUS a percentage for reimbursement are long gone. Businesses have to run leaner and meaner than ever.

The cost of doing business is up and profit margins are down. This is the result of the influx of new and more expensive drugs, prescription volume, managed care and the regulatory issues that require the rethinking of security, coding and overall information management. As contradictory as it may seem, technology can support cash management. Technology is the tool that manages the information you need to run your business successfully and keep a watchful eye on cash and its movement through, in or out of the business.

Technology ultimately supports one thing, cash management. Reporting mechanisms and access to information is integral to making informed decisions about the business. How can you get the information you need without technology? How can you make management decisions, without information? The key is to present that information, in specific formats that are useful in making good decisions.

Data management must support the strategic goals of the business: profitability, cash flow the age and position of receivables. How can a business be effectively managed without data?

Can You Answer the following Questions?

1. Are you getting paid the full contracted amount on each third-party payer claim?

2. Can you verify that you are being paid the full contracted amount on each claim?

If the answer is not "YES", Call 727.474.1300 today!

The Company's Software and Database Services Audit the dollar amounts paid by the PBM.

The Company's proven solution stops revenue leaks and provides Business Intelligence Tools to optimize Third-party Contract Negotiations.

Trust our Company to Audit Claims with passion and ethics that are needed to reduce fraud and fight for the Hardworking small pharmacy owners.

Our Products + Services = Profit and Growth for You

START THE PROCESS TODAY

STEPS:

Collaborate and Join our Effort to Establish a large network of pharmacies who wish to collaborate on a single Health Information Exchange Network designed for Pharmacy

Call Me Today! Carl Heffner , Founder 727-474-1300

The Pharmacy Contracts are loaded in our Contract Version Control Solution, Auditing all changes and who authorized the changes

The pharmacy sends its claims via FTP for analysis

Price lists from your PBM are loaded or derived based on the "Ingredient Cost" Paid

Underpaid Claims are reviewed multiple times by the system to reduce the risk of missed or overlooked claims

The claims are made available through our RxPERT WEB Portal

Claims are grouped and detailed "Reasons" are listed for each problem found (ie. Drug Misclassified as a Generic by the Plan's Processor, Old MAC List Used, Dispense Fee underpaid, etc.)

Take Control and Negotiate Better Terms with PBM's

Your Sales and Contracting experts simply plug in new terms, formularies or MAC Lists during negotiations to determine how new rates, will influence the "bottom line". The system will calculate acceptable terms based on historical claims data.

Pharmacy Technology Specialists

Additional Services offered

Pharmacy Management Systems
Pharmacy System Interfaces
Data Warehouse Specialists
Drug Databases (FDB, MediSpan, Micromedex, and Gold Standard)
Claims adjudication and billing solutions
Electronic Prescription Solutions
Web Refill and Rx Lookup
File Conversions
Business Analysts
Hardware and Integration Consultants
Develop Custom Solutions to Centralize Pharmacy Files

Contact Information:

Carl Heffner , CEO and Founder
1-727-474-1300 (Voice)
cheffner@hisdata.com

"The Best Way To Predict The Future Is to Invent It."

Dr. Richard Feynmann

Pharmacy Challenges

Retail Pharmacy is a necessary component of the United States Healthcare System. Every day, millions of prescriptions are safely distributed to consumers to keep our families safe and healthy.

Retail Pharmacy is in a highly competitive market and is faced with many challenges. These challenges are a result of higher costs and utilization of prescription drugs which are primarily paid for by an individual’s health insurance.

Today, Nine out of ten individuals who purchase prescriptions from retail pharmacies have prescription drug coverage from a third-party prescription drug program (PDP). The plan sponsors whom administer these PDP contain costs by cutting the reimbursements paid to pharmacies. Pharmacy operators cannot afford to lose volume; therefore most are forced to accept less than optimal reimbursements rates. (HIS's Claim Review Process)

Retail Pharmacies are overworked, managing operational issues and caring for their patient’s needs and do not have the time to manually review each claim to determine payment accuracy.

Are you getting paid the full contracted amount on each claim?

With RxPERT CM, a complete “end-to-end” Contract Management and Claims Analysis Engine, each “actual” paid claim transaction is compared to the system generated “expected” claim for accuracy (View Example). All non-compliant claims are then reported back for follow-up. Our Goal is for your organization to have the transparency and bargaining power needed to collect underpaid dollars and negotiate the most favorable contract terms.

Reports

Contact Us for Additional Information

(Product Info, Partnership Opportunities, Investors, Etc.)

Take Advantage of HIS's RxPERT Profit Recovery Solution

According to a recent study by The Lewin Group, claims inefficiencies in the healthcare system cost the nation more than $150 billion a year.

2009 Legislation to Regulate Phamracy Benefit Managers

Retail Pharmacy Organization Establishes Model Legislation to Regulate Pharmacy Benefit Manager (PBM) Business Practices:

NCPA has prepared model legislation as a regulatory framework for states to consider when addressing PBM business practices. The model language provides standards and criteria for the regulation, solvency and licensing of PBMs. Those standards include transparency, substitution criteria, fiduciary requirements and contract provisions.

Pharmacy Benefit Managers (PBMs) serve as large brokers for insurance providers.

PBMs may offer a wide variety of services, but most commonly establish and manage formularies, establish payment rates for participating pharmacies and process and analyze prescription drug claims

New Laws, Bills and Industry Standards will address PBM Proprietary Business

Practices mandating Transparency, substitution criteria, fiduciary requirements and contract provisions will reduce HIS’s implementation time significantly.

Pharmacy Benefit Managers

Pharmacy Benefit Managers, often known simply as “PBMs,” are largely unrecognized by most employees—and even by many benefits managers. But they have a tremendous impact on U.S. health care decision-making because they influence more than 80 percent of drug coverage.

Bottom Line Results

Identification And Recovery Of All UnderpaidDollars

Negotiating The Most Favorable Contract For Your Business
Provide Pharmacies With Similar Reporting Tools Used By The Very Profitable Pharmacy Benefit Management Companies (PBM)

Your Organization To Have The Transparency And Bargaining Power Needed To Negotiate Most Favorable Terms As Opposed To Being Forced To Accept Unprofitable Contracts

Demanding Profitable Reimbursement Rates, MAC Pricing, And Drug Formularies Based On Its Own Supply Chain.

Contract Version Control Solution

Health Intelligence Systems

Pharmacy Contract Management Automation