Your Data Matters: Enabling Pharmacy Claims Processing in the Cloud

By: Linda Campbell, director, product management


Learn why the cloud is the best solution for helping ensure the security, reliability, and speed of processing your organization’s pharmacy claims.

Protecting your data is of utmost importance and should drive plan design recommendations. The health of members and the security of data should be managed using the latest cloud-based technology. Here’s why the cloud is the best solution for ensuring the security, reliability, and speed of processing an organization’s pharmacy claims.

The Cloud Is the Future of Data Storage and Management

Adhering to government regulations for pharmacy benefit services

While providing pharmacy benefit services, local, state, and federal regulations often require the claims administrator to provide faster business-rule modifications. As regulations often change and come up quickly, a pharmacy benefit manager should be agile and adaptable to future regulations and plan requirements that benefit an organization.

Anything stored or managed outside the cloud usually requires long periods of time to meet regulatory changes. Cloud usage can enable and facilitate any type of change—from a simple plan design change to more complex overhauls—to occur rapidly with ease. 

Data access, security, and member privacy

Now, more than ever, we need to consider how and where our data is stored and accessed. Cloud data storage offers the highest data security available today, including improved security against ransomware and cyber threats. Cloud also allows for automatic data scalability and availability, including built-in disaster recovery to ensure your data is always safe and secure. When deciding on whether you want to move your organization’s data to the cloud, consider the following additional benefits:

  • Provides robust security without a Citrix or VPN connection.
  • Allows web-based authorized access to your stored information and data.
  • Built around industry standards for member security, like HIPAA and HITRUST®.

Increasingly, healthcare organizations are leveraging cloud technologies to improve efficiency, productivity, and security, all while containing costs. For example, many organizations rely on Change Healthcare’s self-service tool which allows multiple users to view the information they need to monitor their prescription drug benefit activity. This gives valuable summaries and detailed information regarding claims as well as a claims dashboard for an on-screen visual regarding claim activities. These tools also offer real-time data feeds of each claim as well as a daily file of the previous day’s transactions.

We take data seriously. All of this is done on Change Healthcare’s highly secure, reliable HIPAA-compliant platform. With a focus on data privacy and security, Change Healthcare’s policies automatically enforce system password changes on a predetermined schedule and provide strict scrutiny regarding access to users who have a need and a right to see the data.

Given the tremendous benefits of cloud pharmacy claims processing, the health of members and security of data are managed using the latest technology. Enabling cloud-based technology helps enhance the member experience, improving workflows and efficiency of the organization.

Focusing on the health and well-being of your plan participants

Plan participants deserve individualized attention. When it comes to choosing a pharmacy benefit manager, look for a partner that provides high-quality customer service to enhance the member experience and helps ensure they’re getting the most suitable medication at the lowest cost.

Partnering with the right team can help you navigate the complexity of pricing in the healthcare system and provide the right expertise and exceptional customer care to succeed.

Change Healthcare offers plan designs that provide members with choices for drugs: those that may appear to be high-cost, “out of reach” medications and/or those requiring administration by a specialist.

In addition, Change Healthcare recently developed a new claims adjudication platform—one designed with data security and user experience satisfaction in mind. The new claims processing solution will allow clients to experience an innovative system that focuses on simplicity, security, and transparency. The platform includes containerized cloud solutions, resulting in highly secure, efficient, and reliable products and services that deliver the expected output—successful outcomes for both the plan and participants in the management of their pharmacy benefits.

With Change Healthcare, you aren’t forced into a cookie-cutter approach to your benefit designs. With a flexible pharmacy claims processing platform and efficient distribution channel management services, Commercial Pharmacy Benefit Solutions provide pharmacy benefit plan sponsors with more efficient, cost-effective, and easier-to-understand pharmacy benefit services packages, thus allowing plan sponsors to focus on other priorities at hand.  


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