Pharmaceutical Services

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Improve Market Access for Specialty Drugs with
Pharmaceutical Services from RJ Health

At RJ Health our primary business provides payers with pricing, reimbursement and coding information for specialty drugs reimbursed under the medical benefit. Our pharmaceutical manufacturers benefit from access to our wealth of Payer clients to address the many complexities associated with medical specialty drugs. Connection to our vast community of Payer clients will support market share growth and minimize denials along with access to our medical drug intelligence which help provide correct reimbursement and coding of specialty products.

Our Solutions Include:

Payer Coding Communication

Accurate coding and reimbursement of a drug is crucial to the successful launch of a new drug or new drug code. Our Payer Coding Communication offering provides payer awareness of a new drug, a new indication or new drug code. Additionally, we provide guidance to our payer subscribers to ensure that billing and coding information is loaded accurately to minimize product.

Drug Reimbursement and Coding Survey

Drug Reimbursement and Coding Surveys provide Pharmaceutical manufacturers insight by directly surveying National and Regional Health plans. RJ Health will work with manufacturers to develop questions that will yield meaningful feedback and provide actionable insights.

Payer Specific Claim Forms

30-40% of claims for NOC drugs will be rejected due to administrative error. Educating provider billing personnel on correct billing procedure will enable physicians to use your product with confi¬dence. RJ Health will research payer NOC claims requirements and develop custom payer specific claim forms for a new product.

New Drug Pricing Submission

RJ Health can submit to all four pricing sources for new drug, new NDC and/or price change.

Procurement of HCPCS Drug Code

RJ Health consults on and prepares the submission of requests for the creation of HCPCS/CPT® drug/device/service codes. A specific HCPCS/CPT® code for a product/service will streamline the reimbursement process for both providers and payers, which increases the likelihood of correct reimbursement and faster processing of claims.

Competitive Drug Analysis Monthly Report

RJ Health will prepare a monthly/quarterly report which allows a pharmaceutical manufacturer to compare your product(s) with those of your competitors. Additionally, pharmaceutical manufacturers can review product information that is listed in and published by the National Data Sources for completeness and accuracy.

Co-Branded Provider Claims Assist Tool

Co-branded website, RC Claim Assist gives providers and physicians an intuitive and fast method to correctly bill NDC and NDC units for medical benefit pharmacy claims.

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