Simplify Claims and Reimbursement with RJ Health

I am a pharmacy or clinical decision-maker looking to simplify reimbursement for my organization

I work in claims and reimbursement and need to find a better way to clear my queue

I manage provider relations and need to get on the same page with HCPs related to claims

Learn More About How RJ Can Solve Your Claims Challenges


WHITE PAPERS

White papers to help you Control Medical Drug Spend.

WEBINARS

Webinars to help you Control Medical Drug Spend.

DRUG ALERTS

Specialty Drug Pipeline Review to help you Control Medical Drug Spend.

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 Claim Errors

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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  • Avoid incomplete, out of date, or incorrect NDC to HCPCS alignment relationships, NDC Level AWP & WAC pricing and additional drug details useful in claim billing and adjudication.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?
  • Save on wastage and overbilling with maximum dosing and HCPCS/CPT® code unit limits and single dose information for high cost / high utilization medically covered drugs.
  • Reinforce HCPCS/CPT® alignment data for NDCs to uncover savings opportunities and/or inform formulary development, pricing and reimbursement.
  • Save on specialty drug reimbursement and improve validation related to NDC units to HCPCS/CPT® code units conversion.
How can I get ahead of influxes of high-dollar claims for which codes have not been set-up?
  • Fill in gaps related to Unavailable, incomplete, inaccurate or out of date HCPCS/CPT® code level medically covered drug dosing information.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.

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

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.