Start paying pharmacy claims the right way.
Stop fraud, boost accuracy and save money.
PharmaClaim Insight® is a prepayment fraud, abuse and overpayment prevention service. It’s designed to help you strengthen claims payment accuracy, isolate fraudulent providers and reduce pharmacy claims costs. By combining our advanced Code Validator Pro® (rules-based) and Fraud Finder Pro® (profiling) software systems, you get access to better technology. By relying on our experienced clinicians for suspect claim and provider validation, you get better results.
We have a responsibility to protect our client's benefit dollars and HCI makes that easy for us Renee Haas Employee Benefit Management Corp. (EBMC)
The Problem
An estimated 3% - 10% of the national outlay for pharmacy care is lost to fraud, abuse and overpayments annually. By 2013, losses could exceed $30 billion. That's a loss of over $82 million daily.
The Solution
Pay Right. Save Money
Stop pharmacy fraud, abuse and waste. Increase profits and payment accuracy.
Get a Clinician. Get Results.
Our clinical validation process delivers less false positives and better results.
Save Time. Go Prepayment.
Avoid “pay and chase” detection with prepayment analysis on 100% of claims.
Smart Models. Smarter Software.
Get access to the most advanced fraud models and SaaS applications available.
Better Support. Better Service.
Get help from licensed nurses and coders. Get appeals support, reporting and more.
Total Customization. Totally You.
No two payors are alike. Customize your fraud solution down to the last bit and byte.
Real Fast, Real-Time Processing.
You don’t have time to hold up processing. Get real-time protection with real results.
Fraud and Editing. All in One.
Unilke others, we bundle supplemental editing and fraud prevention in one solution.
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