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Advanced Clinical supported by Advanced Technology...a winning combination!
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Limitless Technology
We built our claim processing system from the ground up to offer
complete plan design flexibility and allow benefit changes to be made
easily, on the fly, and in real-time. This single, fully integrated
platform empowers you to drive the benefit design. BeneCard
PBF’s intuitive claim processing system integrates all
prescription claim data with all health information available. Benefit
design modeling and analysis is conducted through our comprehensive
business rule management system and identifies the net effect of a
proposed plan change before any changes are implemented. This allows
our clients to make informed decisions, maximize savings and minimize
member disruption.
Advanced and Innovative Clinical Programs
BeneCard PBF is reshaping how prescription benefits are
delivered. We offer three levels of clinical control strategies
which deliver effective prescription claims utilization management
with an increasing amount of oversight and intervention. The level
of clinical control selected is based on each client’s
prescription benefit goals.
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Development of the BeneCard PBF system was
driven primarly by pharmacists, and our ability to apply
specific clinical oversight is a competitive advantage. Every claim is subject to detailed clinical rules and questionable
utilization is flagged for clinical review, preventing inappropriate
claims and unnecessary waste.
Our programs incorporate objective and clinically
appropriate protocols based on all available patient data and best
practice for overall trend management.
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