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Claims Processing
Serve You uses the RxCLAIM® Online Transaction Processing System that adjudicates pharmacy benefit claims at point-of-sale. This system provides 24-hour processing through its fault tolerant software and uninterrupted power supply (UPS). It also offers multiple central processing units (CPUs) for online, "hot" back-up to ensure continuous, reliable availability and operational flexibility.
It's primary advantages are the system's flexibility and control with edits and plan design. Edits include, but are not limited to, checks on patient eligibility, physician and pharmacy networks, drug formulary, and pricing. RxCLAIM® provides unlimited pricing tables and plan designs, plan parameters, and other plan management functions. It has a flexible, table-driven, benefit design that precludes the need for "hard-coding". All of these modifications and additions are available in real-time for the most accurate transaction edit checking.
Other advantages of the system include:
Formulary management
Drug utilization review
Benefit administration
Management reporting
Patient eligibility/membership maintenance
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