Clinical services are specialized service in the field of Healthcare industry. With acute shortage of clinical experts in market, we can help you to overcome this along with benefit in the form of cost cutting. The Clinical Services offered by Healthtechnolgy.com comprises of an extensive range of value added benefits for clients. The Clinical services team mainly focuses on the maintenance of the rationality of prescriptions so as to provide a better health outcome and maximum end-customer satisfaction. It maintains a help desk with a toll-free pharmacy service numbers that is adequately staffed with trained clinical personnel which include a team of physicians, pharmacists and analysts.
The Clinical Services team is proficient within the following domains:
- Clinical Help Desk
- Utilization Management
- Formulary Management
- Medication Therapy Management
- Therapeutic Interchange
- Adjudication System Maintenance
- Managed Care Services
- Disease Management Services
- Radiology Utilization Management
Clinical Help Desk
Healthtechnolgy.com’s Clinical Help Desk comprises of trained clinical professionals who assist the Clinical Services team in collecting and disseminating information. They communicate with prescribers, pharmacies and end customers.
It is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically it includes new activities or decisions based upon the analysis of a case.
Under Utilization Management, the Clinical Services team at Healthtechnolgy.com administers the following services:
- Prior Authorization: To facilitate Prior Authorization (PA) programs, we have a team of in-house physician-supervised pharmacists. Standard prior authorization turnover time is generally 72 hours where as expedited turnover time 24 hours.
- Appeals Process: In case, there are any appeals against our authorization, we have set a robust Appeal process with board approved doctors managing the appeals.
- Exception Request: This allows the member to receive a non-formulary medication if no formulary medications have proven effective.
- Step Therapy: This refers to guiding plan participants to use the most cost-effective and safest drug therapy (STEP1) and progressing to other more costly or risky therapy (STEP2), only if necessary. This is an industry norm and followed strictly by the Clinical services team at Healthtechnolgy.com.
- Quantity Limit: This refers to set limit on the amount of a drug a member can receive and is applied when the risk of significant side effect increases with doses higher than the FDA-approved dose
This involves managing of the prescription drug formulary that includes:
- Tier reduction or enhancement
- Drug review (both clinical and Pharmacoeconomic analysis)
- Drug deletion or addition
- Imposing utilization management tools
- Promoting safe, appropriate and efficient utilization
Medication Therapy Management
Healthtechnolgy.com offers in compliance with CMS requirements aimed at improving prescription medication outcomes through intelligent drug therapy and is available to all MTM eligible members at no additional cost.
- Under this program, the Clinical Services team selects MTM eligible members based on Medicare Part D criteria. This is an automated process using filters. The team then performs a comprehensive medication review to identify, resolve, and prevent medication related problems, including adverse drug events and then formulating a medication treatment plan.
- Furthermore, the Clinical Services team provides verbal education and counseling designed to enhance patient understanding and appropriate use of their medications. The care delivered is documented and the essential information is communicated to the patient and other primary care providers via telephone, e-mails and fax.
Overall, the MTM program improves the quality of health care by aiding in appropriate use of medications.
This is aimed at reducing drug cost of different plans. It is a prescriber targeted program which identifies high costing drugs and members to the plan and targeting them for an interchange to a more cost effective alternative. This service is aimed at bringing down direct drug cost as well as opportunity cost to the plan.
Adjudication System Maintenance
This process involves the analysis of the claims file generally sent by the pharmacy to the client via the PBM. This file needs to be analyzed to check various parameters before claims processing is performed. The parameters being analyzed include copay, drugs covered, out of network claims, prior authorization, exception etc.
Managed Care Services:
Our services are aimed at cost-cutting by providing expert advice in managed care contract disputes and reviewing discount contracts, contract language and administrative as well as medical denials. We also dish out assistance in developing negotiating strategies.
Disease Management Program:
The disease management program, at Healthtechnolgy.com was put into practice primarily to enhance patient’s adherence to the physician’s prescribed drugs and plan of care. The program aims at expanding the beneficiary’s knowledge about preventive measures and thus, improving quality of health by addressing and then, redressing health-related problems. Our disease management program has helped clients reduce prescription errors, lowering healthcare costs to a considerable extent. The program is supervised and executed by a team of clinical experts from across multiple disciplines, including registered physicians, pharmacists, and medical directors, who have plenty of experience and qualifications under their belt.
Radiology Utilization Management
The Radiology Utilization Management program, a brainchild of Healthtechnolgy.com aims to maximize high quality diagnostic radiology services for patients by enabling our clients to improve the quality of radiology services such as CT, MRI, PET and other nuclear imaging facilities, rendered to their beneficiaries. The services are also targeted at managing echocardiography, nuclear and echo stress tests, interventional cardiology procedures and pacemakers.
Why Healthtechnolgy .com for clinical services?
- 24X7 Multi-Lingual Clinical assistance.
- Provides detail information of the drugs prescribed.
- Information regarding the FDA approved generic alternative of the name brand prescribed.
- Information regarding drug pricing and discounts.
- Helping members to locate the nearest pharmacy outlets.
- Provides the alternatives to a medication currently under shortage.
- Information regarding the advantages of using mail order pharmacy.