What We Do For Payors
Our industry standard medical drug data can guide you in establishing pricing and reimbursement policy, analyze overspending, target outlier claims, educate and build provider compliance.
Our platform of data and software-as-a-service applications gives payors the capability to drive improvements related to medical drug spend. Establishing and enforcing policies through the operational processing of medical claims with administered drugs, is most effective with ReimbursementCodes.
Additionally, RJ Analytics’s goal is to partner with payors to create insight into specialty drug trend and develop methods to effectively manage medical drug spend across their organization.
Finance and Analytics teams use RJH products and services to establish pricing and reimbursement policy, and analyze potential opportunities for cost containment.
Clinical / Pharmacy Operations teams source our data and software as a service application to establish clinical edits in support of case management programs designed to improve outcomes and minimize costs.
Claims adjudication teams use RJH data and software as a service application to review and target outlier claims, increase payment accuracy and reduce risk of appeals.
Network Management sources our data to manage medical specialty drug pricing included in fee schedules.