Improve state Medicaid program outcomes.
Pharmacy Claim Advisor provides real-time claims adjudication, management, and services for state Medicaid programs. Comprehensive capabilities include prior authorization workflow (electronic and manual), drug reference data and rules management, retrospective drug utilization review, SMAC workflow, web-based portal, helpdesk call management, and reporting. NCPDP and HIPAA-compliant pharmacy claims are transmitted to the processor, where client-specific rules and criteria can be applied. Automating these processes maximizes efficiency and drives cost savings.