Automated Claims File Analytics
We’re here to streamline compliance management, ensuring your next audit or
appeal with unwavering confidence and peace of mind.
Here at PHG, we have implemented an automated claims file analytics process that is instrumental in optimizing strategy and rebate yield for clients and achieving substantial savings for clients. By harnessing advanced analytics tools, PHG gains the ability to swiftly analyze vast amount of claims data, identifying patterns, trends and opportunities that might otherwise go unnoticed. This data-driven approach enables PHG to tailor formulary strategies more precisely, ensuring that clients can maximize cost savings without compromising quality. Additionally, the automated process facilities efficient rebate aggregation, streamlining negotiations with manufacturers and vendors. The real-time insights derived from analytics empower PHG to make informed decisions, ad proactively adjust formulary strategies. Overall, our sophisticated analytics framework not only enhances operatio9nal efficiency by also contributes significantly to achieving optimal financial outcomes for clients, fostering a dynamic and responsive approach to formulary management.
Why Compliance Matters
Program management optimization required demands precision and a steadfast commitment to compliance. Compliance and internal audits are integral to this process, and having a trusted partner by your side can make all the difference. That partner is PHG. We’re here to streamline compliance management, ensuring you enter your next HRSA audit with unwavering confidence and peace of mind.
Claims Review and Submission
We recognize that managing 340B compliance is not a one-time effort; it’s an ongoing commitment. Here’s how PHG can be your ally in
this journey:
01
Maximize Savings
We’re dedicated to helping you maximize your program savings. Our expertise ensures that you’re making the most of this valuable program, enabling you to reinvest in patient care.
02
Peak Compliance
Maintaining peak compliance is essential. Our comprehensive compliance management solutions are designed to keep you on track, ensuring you meet formulary standards and rebate eligibility requirements.
03
Optimize Performance
PHG Clinical and Client Service teams work directly with you to ensure formulary adherence and claims submission requirements are being met to ensure compliance, as well as available audit assistance with our knowledgeable and experienced team.
04
Audit & Appeals
In the event of an audit dispute or appeal, we provide the support you need. Our experts can guide you through the appeals process, helping you navigate challenges and achieve the best possible outcome.
340B Optimization: Robust validation algorithm ensuring a consistent and appropriate classification of 340B claims at the pharmacy level. Ensures client value is not inappropriately scrubbed.
Financial Forecasting: Proprietary deep engine forecasting model allows us to apply a forecasted financial value at the claim level and to track that value through the entire claim lifecycle.
Underwriting & Pricing: Nimble and detailed pricing models outlining key drivers in performance expectations. Best in class turnaround times in order to exceed aggressive market deadlines.
At PHG, we are committed to our clients success. Our goal is to make management of your program faster and more efficient, allowing you to focus on what truly matters – providing exceptional service to your customers.