Proprietary algorithms and analytics designed to perform active monitoring of your claims utilization respecting your PBM contractual agreement. Analyzes claim level data against your contract definitions, providing you early feedback of performance, financial impacts and identifying areas for future contract negotiations.
A review and analysis of your pharmacy benefit utilization, highlighting key elements that have an impact on the calculation of financial performance guarantees as well as information to understand and improve your pharmacy benefit plan.
A review and analysis of your pharmacy benefit utilization, not influenced by the PBM vendor. The set of standard periodic reports covers networks, providers, prescribers, therapy classes and other key information for clients. Whether you have been with a PBM for three years or change vendors, your reports are consistent.
PBM’s are well designed for high volume claims processing, but errors occur. Clients utilize the Crystal Clear Rx ClaimWatchRx Design solution to review data and identify questionable claims against the plan benefit design before they become a financial and clinical concern.
A prospective and retrospective review of claims to identify potential fraud, waste and abuse activity.