January 2023 Release Notes
1. Payment Integrity module in Medical Recommendations:
With the new Medical Recommendation, Payment Integrity., users can review claims before and after payment to identify improperly billed, processed, and paid claims, saving plans and members 5-25% of their healthcare spend.
2. Cash Pay module in Medical Recommendations:
The new Medical Recommendation, Cash Pay, provides a direct, transparent, immediate cash-pay model for plan sponsors. An efficient payment platform, proven savings, and care navigation empower employees to choose better healthcare.
3. Formulary Disruption page added to Market Check Report:
The Market Check Reporting Package and Excel export now include formulary disruption details, including claims by tier status and details of drugs categorized as ‘Not Covered’ and ‘Tier Decrease.’ This feature will allow users to evaluate formulary disruption of current and market PBM contracts.
4. Save users activation later:
From the administration screen, ‘Draft Users’ can be added and saved without account activation. This feature allows administrators more control over when users are activated.
5. Clinical drug names replace chemical names:
On every portal screen and most reports, clinical drug names will be displayed rather than chemical names.
6. Generate reports directly from the Market Check screen:
Using the new ‘Actions’ button, users can generate reports directly from the Market Check screen.