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RJ Health’s Payer Solutions:

Your Trusted Source of Medical Drug Coding, Pricing & Reimbursement Data

The U.S. pharmaceutical industry is characterized by a complex and often opaque system of distribution and reimbursement. The complexity of the medical billing and coding leads to an excessive amount of errors from both HCPs and payers that result in a loss of medical dollars and extreme frustration in the healthcare system.

RJ Health provides a normalized dataset of industry standard specialty drug pricing, coding and clinical data to enable payer organizations to reimburse claims accurately and timely, often leading to a decrease in medical drug spend. Our solution, ReimbursementCodes, is the most trusted, comprehensive suite of coding (HCPCS/CPT®, and NDC), pricing (AWP, WAC, ASP, and CMAC) and clinical crosswalks (ICD10, Min/Max, and Age/Gender) to accurately support reimbursement.

Use Payer Solutions to:
  • Gain insight on where coding errors occur and how to correct them
  • Improve reimbursement accuracy with a unified view of drug coding and pricing information
  • Define medical drugs by cost, route of administration and therapeutic class to reduce the time it takes to process claims
  • Stay informed about new specialty drug pricing updates and get ahead of an influx of high-dollar medical drug claims
  • Automate coding and pricing reconciliation with regular updates for healthcare codes needed for medical drug billing
  • Leverage an NDC and NOC crosswalk to validate claim-specific reimbursement

Please enter your information on the left to learn more about how you can take advantage of Payer Solutions.

Solving market access challenges is all we do.

Meet the Experts Video Highlights:

RJ Payer Solutions to Simplify Pricing, Coding & Reimbursement

Clinical Case Study: Nuanced ICD-10, Min/Max and Age/Gender Policy Implications

Pricing Case Study: Solving Overpayments through Fee Schedule Development

Provider Network Case Study: Reducing Frequency of Medical Errors

View Full Recordings

Use Cases:

Clinical & Pharmacy                                                                                               

Clinical & Pharmacy                                                                     

How can I reduce the amount of misaligned HCPCS/CPT and NDC codes my team deals with?
> Comprehensive current and historical HCPCS/CPT® prices for medically covered drugs.

> Accurate and comprehensive NDC to HCPCS/CPT® cross-walk data for medically covered drugs.

> Avoid incomplete, out of date, or incorrect NDC to HCPCS alignment relationships, NDC Level AWP & WAC pricing and additional drug details useful in claim billing and adjudication.

 

How can I reduce the amount of inconsistent claims based on reimbursement policies?
> Maximum dosing and HCPCS/CPT® code unit limits and single dose information to identify overbilling and wastage for high cost / high utilization medically covered drugs.

 

> Reinforce HCPCS/CPT® alignment data for NDCs to capture savings and/or inform formulary development, pricing and reimbursement.

> NDC units to HCPCS/CPT® code units conversion for validation and accurate reimbursement.

How can I get ahead of influxes of high-dollar claims for which codes have not been set-up?
> Maximum dosing and HCPCS/CPT® code unit limits and single dose information to identify overbilling and wastage for high cost / high utilization medically covered drugs.

 

> Reinforce HCPCS/CPT® alignment data for NDCs to capture savings and/or inform formulary development, pricing and reimbursement.

> NDC units to HCPCS/CPT® code units conversion for validation and accurate reimbursement.

Claims & Reimbursement Analysis                                                                     

How can I reduce the amount of time that is spent on each high-dollar claim?
> Fill in gaps related to Unavailable, incomplete, inaccurate or out of date HCPCS/CPT® code level medically covered drug dosing information.

> Gain real-time access to Missing off-label dosing standards due to incomplete Compendia sourcing.

> Leverage the most comprehensive crosswalk for HCPCS/CPT and NDC coding either as a reference tool or fully automate claims.
Where can I go for the source of truth related to reimbursement policies?
> Leverage the industry standard for Current and Historical HCPCS/CPT® (Reimb) Code and NDC Pricing, Drug Detail, Dosing, Diagnosis, Medicaid Rebate and NDC Alignment and Conversion Data for Medically Covered Pharmaceuticals.

> Realize operational efficiencies through the ability to access (24/7), interact with and manipulate medically covered drug detail, coding crosswalk, pricing, conversion, dosing, and diagnostic data.
How can I eliminate excess drain on my team’s resources due to claims disputes?
> Appropriate drug administration and diagnostic codes (ICD-CM-10) related to medically covered drug HCPCS/CPT® (Reimb) Codes.

> Maximum/Minimum dosing and HCPCS/CPT® code unit limits and single dose information to identify overbilling and wastage for high cost / high utilization medically covered drugs.

> Avoid unavailable, incomplete, inaccurate or out of date data for Administration code data aligned with specific HCPCS/CPT® codes. Enable other departments to access this data directly.

Provider Network                                                                                           

Provider Network                                                                           

How can I enable my providers to submit claims correctly using NDC codes?
> Provide your provider network with a direct portal to your reimbursement policies and how to submit claims using correct HCPCS/CPT and NDC crosswalks.

> Eliminate confusing or unavailable NDC unit and pricing data to be used to convert to and from HCPCS/CPT® codes.

> 24/7 access to medically covered drug detail, coding, crosswalk, pricing, conversion, dosing, and diagnostic data.

How can I reduce my team’s dependence on our clinical and claims teams?
> 24/7 access to medically covered drug detail, coding, crosswalk, pricing, conversion, dosing, and diagnostic data

> Eliminate confusing or unavailable NDC unit and pricing data to be used to convert to and from HCPCS/CPT® codes.

> Current NDCs and their strength, package details, billing units and conversion factors for active medically covered drug HCPCS/CPT® codes.
How can I reduce our backlog of under/overages?
> Realize operational efficiencies through the ability to access (24/7), interact with and manipulate medically covered drug detail, coding crosswalk, pricing, conversion, dosing, and diagnostic data.

> Appropriate drug administration and diagnostic codes (ICD-CM-10) related to medically covered drug HCPCS/CPT® (Reimb) Codes.

> Effectively manage medically covered drug costs and utilization by limiting coverage to appropriate Administration codes.

Our Solutions

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