A top national PBM needed an efficient process to review pharmacy claims for discrepancies/errors prior to payment. EXL Healthcare’s auditor expertise and IT resources developed a scalable and repeatable program across all lines of business to avoid inappropriate payments. As a result, the client:
EXL works with pharmacy leaders to deliver end-to-end services that drive efficiencies, effectiveness and quality outcomes across their business.
Control costs associated with incorrectly billed or overpaid pharmacy claims, focusing on prevention, avoidance and recovery.
To learn more about EXL Healthcare Payment Integrity offerings, click here. [+]
EXL services PBMs and payers (Commercial, Medicare, Medicaid health plans) that share the responsibility of ensuring high-quality patient care while minimizing costs.
For businesses that aren't satisfied with good enough, or profitable enough, we use Digital Intelligence to deliver real results.
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The primary goal shared by healthcare stakeholders is to improve the quality of patient care while reducing costs.
We deliver services that empower pharmacy leaders to focus on what matters most – addressing quality care gaps, maximizing operational efficiencies, containing costs, enabling capacity growth, improving medication adherence, and ensuring appropriate medication utilization.