Can a claims analysis be conducted to identify the potential savings opportunity?

Syrtis consultants are readily available to conduct a claims analysis and provide quantitative reports that outline savings potential.

To learn more, or to schedule a free claims analysis, contact Steve Konsin at SKonsin@SyrtisSolutions.com, 703-628-3517.

How long will it take to implement ProTPL? What technical resources are needed?

Program implementation can occur as quickly as 60 days and requires very little technical resources from our customer. Essentially just creating a new file output and secure file transfer process.

The implementation timeline is dependent only on the length of time needed to reach an agreement and set up the files transfer processes. ProTPL uses standard NCPDP Pharmacy and ANSI 12 eligability datasets.

Will ProTPL disrupt the pharmacy process?

ProTPL is seamlessly integrated into NCPDP Pharmacy and ANSI 12 eligibility standards to avoid disruption at the point of sale for both the pharmacy and the patient.

After the initial claim is filled, all future claims are cost avoided automatically as the pharmacist has updated the system to prospectively channel the claim to the other health plan.

What are the advantages of accessing the Surescripts network?

The Surescripts network is the nation’s first and largest health information network. Unlike other networks, Surescripts provides access to patient information, in real-time, directly from the payer sources.

This ensures that eligibility data is current, thus mitigating false positives that can occur when health plan information is 30 days old.

Who is ProTPL designed to help?

ProTPL is designed to help governmental agencies, MMIS providers, pharmacy benefit managers (PBM) and payer of last resort health plans reduce manual pay and chase processes that retrospectively identify and track down primary payers for reimbursement.

In addition to a transparent provider model, the program is available as a private-label solution.

What percentage of claims have other pharmacy coverage?

Test data demonstrates that between 6% – 13% of all claims submitted under payer of last resort health plans, excluding Part D, are found to have other pharmacy coverage. Through a prospective cost avoidance solution, claims with other coverage are identified in real-time at the pharmacy point of sale.

In addition to cost avoidance, this information is used to retrospectively recover pharmacy claims previously approved, as well as to identify additional medical dollars that can be recovered both retrospectively and prospectively. The program complies with all federal TPL requirements and reduces inefficient pay and chase methodologies.

How does Syrtis Solutions support third party liability regulations?

All private or public healthcare plans, unless specifically excluded by Federal statute, must meet third party liability (TPL) legal obligations to pay claims before Medicaid, or other federally-sponsored healthcare programs.

ProTPL, a service of Syrtis Solutions, enforces TPL obligations to effectively cost avoid pharmacy claims in real-time when other coverage outside of Medicaid exists. In addition to cost-avoiding pharmacy claims, the program helps to identify, recover and cost-avoid medical claims.